Home Forums Melanoma: Newly Diagnosed – Stages I & II Stage 1a help with Path Report

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    I was diagnosed stage 1a ssm.

    My summary is as follows:

    Hist type: SSM

    Max tumor thickness: 0.27

    Anatomic Level: 2

    Ulceration: Not identified

    Periphial Margins: Uninvolved by melanoma in the plane sectioning

    Deep Margin: uninvolved by melanoma

    Mitotic Index: 0/mm2

    Microsatellitosis: Not identified

    Lymph-Vascular Invasion: Not identified

    Perin Invasion: Not identified

    Tumor-infiltrating Lymphocytes: Present, non-brisk

    Tumor Regression: Not identified

    Here is the microscopic exam notes:

    There is a circumsized but asymmetrical compound melanocytic neoplasm, the epidermal component of which reveals focally markedly atypical epitheiloid melanocytes with abundant melanin throughout all epidermal layers. There is only a very focal invasion of the pappillary dermis by few single and one small island of atypical melanocytes. There is a dense perivascular and nodular superficial lymphocytic infilteate with numerous melanophages.

    How do I interpret this? I had the WLE and those margins came back clear. Thanks to everyone on here. I have had many sleepless nights


    Hello, have you read the sections on newly diagnosed and understanding pathology? Those might be helpful to read.

    Our pathology reports are almost identical (mine was 2.5 years ago). This is pretty thin. Puts you at Stage IA. I think Catherine and others would tell you this is a pretty low risk lesion, congratulations on catching it early. Be vigilant about your skin, monitor any changes, get frequent skin checks/exams, etc. . After wide excision, there probably isn’t much else. This has a very good prognosis. You’ve come to a great place for information/discussion. Sorry you joined us, but the prognosis for this type of lesion is in the very high 90s, probably 97%, 98%, not 100% but still very good. I’m not a doctor, but this is what I gather from what I’ve learned.

    Catherine Poole

    I agree, you are very fortunate to have a low risk lesion that you most likely will never deal with again. Do keep up the self exams and get regular dermatology exams. You might also like to view our pathology webinar with expert, Martin Mihm: http://melanomainternational.org/webinar/2012/07/understanding-your-melanoma-pathology-2/#.Uodvf8RQHJc

    Keep up the good work and try to relax and enjoy each moment.


    Thanks for the replies! I guess my question pertains to the summary. Is most of this lesion in situ and only a very small part invasive in the dermis?

    Also, how do I know if this was radial or vertical growrh stage?

    When you hear the “C” word it is a shock to the system. Even though statistics say odds are in my favor, odds were in my favor to not get a melanoma as 1 in 50 or so people in the US will be diagnosed with one. In my book that’s only 2 percent of the population, so saying my odds are 98 percent in my ifavor does not really excite me.


    Growth phase is subjective, and not all pathologists even comment on it. But you can ask or if you get another opinion it may include growth phase. I know what you mean about the %, I’ve thought the same way. If I was in the 2% to get melanoma, why can’t I expect to be in the same 2% to have their thin melanoma spread? But the bottom line is since it’s not 100%, it’s the next best thing I guess.

    Catherine Poole

    Some pathologists don’t use the vertical and radial growth phase in their report. They should. But nothing is standardized. As for getting a 100%, nothing in life is guaranteed like that and certainly you won’t get it when there is a possibility of liability. I think it is much healthier to look on the brighter side of things and be thankful for this wonderful prognosis. Then live each day to the fullest, taking time to enjoy the moments.


    Thank you so much everyone. I have never truly been scared in my life until I received the diagnosis.

    I do have another question. My report was prepared by a Dermopathologist at the University of Cincinnati. How accurate are these pathology reports typically? I ask because if I received a second opinion and it was less favorable, then I would want a third opinion, etc.


    There is some subjectivity with the pathology. It’s not black or white, there is some gray, and so pathologists might differ slightly on some things. I obtained a few different opinions; they all pretty much were the same on Breslow, Clark level, ulceration, etc. . .but differed slightly 0 mitosis or 1, radial or early vertical growth, no regression or partial focal regression, etc… I think some of these things can differ pathologist to pathologist, but you had a dermatopathologist so that is good, I still don’t think there is anything wrong with getting another opinion. We get 2nd opinions on our car repairs, home repairs, etc. . .what’s more important than our own health?! Never hurts I guess. If something differs vastly, then you can get a third opinion. If it’s pretty much the same, then you can be reassured it’s correct. I’m not sure what the % is of pathology mistakes/errors, Catherine probably would know that if there’s some statistic or something.


    I’m sorry you’ve been dx with melanoma, but it does sound like a very low risk lesion.

    The pathology has no alarming features. It was only focal invasion (small area of invasion). It is most likely radial growth phase bc it had no mitotic index. The melanophages are just cells that were attacking/ingesting the tumor and common in melanoma pathology. A second opinion on path is always a good idea – and the norm for other types of cancer.

    Best wishes!


    Thank you for the continued responses. I do have another question regarding second opinions. Being in Ohio, where is it recommended I go for another opinion? Also, what is the likelihood the diagnosis could come back worse? Just thinking about it makes me feel like I am reliving that week between the biopsy and results intially.


    You can have it sent anywhere for a 2nd opinion. I live in Chicago area, and sent to New York, Texas and Massachusetts. It sounds like your first pathology report was pretty thorough, I wouldn’t imagine there would be some huge major difference. There could be some differences, pathology is not black & white. Like Worrywart said, a second opinion on path is always a good idea – and the norm for other types.


    Is that something you arrange through insurance? How do you get the ball rolling? Contact another facility first?


    Depends on your policy, if you’re unsure what is covered check with insurance. Then you just have the place that has the slides now send them to where you want them sent (probably some release form or something). If you wanted to use Mihm:

    Contact them first before sending your slides, though, I think there is a form to also fill out with demographics, billing info, etc…

    Martin C. Mihm Jr., M.D., F.A.C.P.


    One Broadway

    Suite 14

    Cambridge, MA 02142


    You might have better luck and a quicker response by sending an email directly to this person:

    Rolanda Flammia

    Assistant to Martin C. Mihm Jr., M.D.

    Director, Melanoma Program

    Department of Dermatology

    Brigham and Women’s Hospital

    41 Avenue Louis Pasteur

    Alumnae Hall, Room 317

    Boston, MA 02115



    E-mail- rflammia@partners.org


    When I got a second opinion I simply called my derm and told her I wanted a second opinion on pathology, located a dermatopathologist that specialized in melanoma, and gave her the address to send it too – she took it from there.

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