Home Forums Melanoma Diagnosis: Stages I &II Should I get another opinion?

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  • #20583
    Jenni
    Participant

    Hi everyone!

    I will try to make this short and concise :)

    I had two small moles removed in June by a local derm last minute before I took my trip to France. The pathologist called the one on my leg mildly atypical and the one on my stomach moderately atypical. They were shallow shaves and she suggested conservative re excision because of my past. My derm actually said it wasn’t concerning to her and we could leave them alone. The one on my leg looks gone and the one on my belly (moderate) seems to have a tiny bit of color left.

    SO, I send them to UCSF pathology for a second opinion. Today I get back something I wasn’t expecting and I was looking for advice. I have yet to hear from the actual derm at UCSF that is going to call me, this is what the report says.


    1.

    Final Diagnosis

    LEFT UPPER ABDOMEN

    LENTIGINOUS JUNCTIONAL MELANOCYTIC NEVUS, EXCISED IN PLANES OF SECTION EXAMINED

    Gross Text

    One outside slide, S-12-14202:B1-1.

    Microscopic Description

    There is a proliferation of melanocytes, mostly at the dermo-epidermal junction. Most are arranged singly at the sides and bases of elongated rete ridges, but some small nests are also present. There is hyperpigmentation of the basal layer.

    (THIS IS the one on my belly that had the moderate read from before and seems to have a dot of color left), would you leave it as is?


    2.

    Final Diagnosis

    LEFT LATERAL THIGH

    JUNCTIONAL MELANOCYTIC NEVUS, WITH SOME FEATURES OF THE PIGMENTED SPINDLE CELL VARIANT OF SPITZ’S NEVUS, EXCISED IN PLANES OF SECTION EXAMINED

    Microscopic Description

    Sections show a proliferation of melanocytes arrayed as nests along the junctional zone, and some junctional nests are composed of spindled cells with pigmented cytoplasm.

    (NOW, this one didn’t scare me BEFORE, now it does, as I know that spitz nevi can be super close to melanoma (in appearance). SO, what would you do about this one???)


    Just as I think I am getting to a place where I am comfortable with my skin I get news that shakes me (a bit), granted, I am trying to keep my head straight and not jump to conclusions as well. My husband thinks I am looney and that I worry to much. Thanks for listening! And any thoughts are appreciated!

    Best,

    Jenni

    #56219
    Jenni
    Participant

    One other thing I forgot to mention,

    The one on my belly was always there, just a bit darker over the last year…since pregnancy I think.

    The one on my leg (spitz features) was brand new in the past year, but tiny, like barely 2 mm and lighter brown, sorta spotty looking and raised and about 2 mm from an old tiny darker round mole. I wanted it off bec it was new. Otherwise, it looked ok.

    Thanks everyone.

    Jenni

    #56220
    cohanja
    Participant

    This answer is probably not much help, but thought I’d throw in my experience. Since my melanoma, I’ve probably have 30 biopsies. Many, many have come back mildly atypical with path reports that have lots of scary sounding stuff in them, and sometimes margins are even involved. I’ve never gotten 2nd opinions on any of them since there are so many and I didn’t think mildly atypical is close to melanoma. Also, I’ve never had any re-excised, even if margins involved, since they dont’ seem concerned very much with mildly atypical. A lot of what you have in your path reports (except the “spitz” part) I have on many of my reports too. I guess I wonder if I should be getting 2nd opinions, but it would be so many to do that with, and so I figure if something comes back moderately or severely atypical, then I’ll get another opinion.

    #56221
    cohanja
    Participant

    Here’s an example of one: “Compound dysplastic nevus with mild atypia extending to one lateral margin. Sections of skin show lentinginous proliferation of the rete with horizontally oriented, confluent nests and individual melanocytes along the epidermal-dermal junction. The underlying dermis contans aggregates of mature melanocytes. There is fibroplasia of the papillary dermis as well as minimal telangiectasis and lymphocytic inflammation. The junctional component of this lesion extends beyond the intradermal portion and demonstrates focal mild cytologic atypia of the melanocytes. Melanocytes extend to one lateral margin of the specimen. There is no evidence of malignancy.” The Dr and pathologist both said no further excision is necessary with this. They didn’t see concerned. I don’t know if this is worth a 2nd opinion on, I’ve had others like this as well. I guess I don’t know if the melanocytes remaining with mild atypia could one day become malignant, or if I should just watch and if I ever see pigment there again, then get excision, etc.. The report has a lot of stuff I have no idea what it is but sounds bad. . .telangiectasis, fibroplasia, lymphocytic inflammation, etc…

    #56222
    Catherine Poole
    Keymaster

    I am not alarmed by these pathology reports Jenni. But if you are and want another opinion, go for it. You could try Dr. Mihm (drmihm.com) if you want to go outside of your area. Boris Bastian who is now at Sloan Kettering is an expert on Spitz Nevus. But all in all sounds like just moles and melanocytes which are normal.

    #56223
    Jenni
    Participant

    Thanks Cohanja! Reports can sound really disturbing and be pretty much nothing :)

    Catherine, is it normal for one pathologist to call something mildly atypical and then have features of a spitz nevus? I guess that for me is sorta a big gap in reading the pathology which is why I am questioning it at all. If it is benign or atypical, fine, I have no issues going on….but I sorta freaked because adults shouldn’t grow a spitz nevus, now, should we? It seems to be something a child has. This is a new mole within the last year.

    I am waiting to hear back from the derm at UCSF. I have seen her twice (as backup to my regular checkups at Stanford) and she runs a PLC, so I assume she can give me the info I need :)

    Thanks

    Jenni

    #56224
    Worrywart
    Participant

    I would not worry. It has some features of spitz, but it doesn’t even say how atypical it is, which makes me think it’s totally benign. The first report just didn’t include as many details. It doesn’t say anything about the diagnosis being difficult or that they were unsure if it is melanoma or spitz, but maybe another opinion from an expert will ease your mind. I like all mine fully excised so if they aren’t I’d do that and then forget about it.

    #56225
    cohanja
    Participant

    So, you’d get one like mine fully excised. . mildly atypical that extends to lateral margins? My Doc isn’t doing that, but I could insist on it if I should.

    #56226
    Catherine Poole
    Keymaster

    Jenni,

    Yes adults get spitz nevi but either diagnosis isn’t worrisome. I think a third opinion would benefit you and I would do so with Mihm or Bastian. They are very expert, Mihm is off teaching the world about dermatopathology and Bastian has made some great discoveries.

    #56227
    Jenni
    Participant

    Thanks Catherine.

    I will wait to hear from the derm at UCSF, I assume I should hear from her today or tomorrow after all the messages I have left :) AND then go from there. If I get another opinion I will go to Mihm first, I think. I have heard so many good things about him!

    I have a derm appt a week from Wednesday at Stanford, I wonder if I should just tell them to take a tiny bit more from these shaves and then be done with it to make sure they are all gone :) I am trying to get past all the worry and enjoy my baby girl!

    Best,

    Jenni

    #56228
    Jenni
    Participant

    Update: Saw the derm at Stanford for my normal 6 month checkup, all good. Showed her the two different reports that I posted here and she says she doesn’t feel either one are anything to worry about.

    Also, got a call from the derm at UCSF, the pathologists looked again at the slides and said that neither look suspicious and that both are ok to be left as is. They don’t like to use the word atypical or dysplastic the derm told me because they feel they are misleading…..they are ok just look funny and they don’t like to cause extra stress by saying they are atypical, just an fyi, for UCSF :)

    SO, I am gonna let it all go, I think I am in a good place. Stanford and UCSF are respectable place I think, so I will relax and move on.

    Jenni

    #56229
    scienceteacher89
    Participant

    Hi Jenni,

    Glad to hear that your visit went well.

    #56230
    Catherine Poole
    Keymaster

    I know my doc called dysplastic nevi “funny looking” moles. My husband has them, a little nerve wracking when I deal with melanoma so much, but I’ve gotten used to them and stopped circling them with a pen. He is followed with photography and regular checks. So yes, they can be disconcerting, but aren’t necessarily something to be worried about. Just follow them. I’m glad you got this all cleared up! :)

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