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July 17, 2012 at 3:12 am #20487
Time to celebrate. Everything is wonderful today. Clear, all CLEAR!
We are having fun making jokes about my “fat back.” It doesn’t look fat
Having an evening surrounded by those i love.
I know some like details, so here is the full report.
Thank you for all the help and support. God bless.
Date: 7/ll/2012 Tim6: 10:08 AM
TO: HAYASHI M.D., HOWARD
SB Jobst MD JB Hannah MD CL Douglas MD
BD Ragsdale MD RE Rocha MD KF Lundquist MD
KL Ferguson MD MV Frost MD GC Ponto MD, DM Lawrence
Tel: (805) 541-6033 ‘ Fax: (805) 541-6116 –
SURGICAL PATHOLOGY REPORT
Patient: ROONEY, KRIS J Accession #: CPS-12-04259
DOB; 2/19/1952 Sex: F MRN: Date Collected: 7/6/2012
Physician: HAYASHI, HOWARD M.D. H3151 Date Received 7/6/2012
SPECIMEN RECEIVED: A) Skin
CLINICAL HSTORY: Re-excision of melanoma, upper mid back
CROSS DESCRIPTION: Received in formalin and designated on the requisition as “stitch at 12:00” is a skin ellipse measuring 7.5 x 3.2 cm that is excised through adipose tissue to a depth of 4.0 cm. A suture is present at one skin short cross-sectional margin denoting the 12:00 position. At the epidermal surface is an ovoid ulcer measuring 2.5 x 2.0 X 0.3
cm. The specimen margins are inked as follows: 12-3:00 = black; 3-6:00 = blue; 6-9:00 = green and 9-12:00 = yellow. The deepest most adipose tissue margin is marked orange.
The specimen is serially cross-sectioned from the 3:00 tip to the 9:00 tip into seventeen slices designated slices 1-17, respectively, from 2:00 – 9:00. Slices 8—13 display the dermal ulceration. The skin is thickened in all slices and no discrete nodularity is identiﬁed.
The subcutaneous adipose tissue is soft, uniformly yellow and unremarkable.
All skin is submitted as follows:
Al = slices #1 and 2; A2 = slices #3 and 4; A3 = slices #5,6
A4 = slices # 7 A5 = slice #8; A6 = slice #9, A7 = slice #10;
A8 = slice #11. A9 = slice #12; A10 = slice #13; All = slice #14; A12 = slices 15 and 16; A13 = slice #17
MICROSCOPIC DLAGNOSIS: ~
Skin, upper mid back, excision:
– NO RESIDUAL MALIGNANCY REPRESENTED (see Note)
– BIOPSY SITE CHANGES IN THE CENTER OF THE SPECIMEN
– INCIDENTAL BENIGN INTRADERMAL MELANOCYTIC NEVUS, EXCISED
NOTE: A previous biopsy at this site (WDS-12-42014, FN34-12) revealed a malignant melanoma, superﬁcial spreading type, Clark’s level II, 0.55 mm Breslow thickness that was narrowly excised and associated with a compound dysplastic nevus.
The current re-excision specimen contains a benign intradermal melanocytic nevus that is excised, but no residual melanoma.
This test was performed at 3701 s. Higuera Street, San Luis Obispo, CA 93405
Michael V. Frost, M.D., Director
Central Coast Pathology, 3701 S. Higuera Street, Suite 200, San Luis Obispo, California 93401July 17, 2012 at 9:09 am #55520bon15Participant
Congratulations! Just wondered though was there any particular reason your excision went so deep? My melanoma was 0.72mm and “superficial” Clark 4 and this was excised to a depth of only 1cm compared to your 4cm. Perhaps it all depends on the depth of skin/ fat in the area of the melanoma site…July 17, 2012 at 9:51 am #55521 I believe it should go down to the fascia – so however deep that is in the area being excised. . as long as it goes down to that layer. I think.July 17, 2012 at 10:11 am #55522 Going back to my report, mine was excised to a dept of 2.4 cm; but, said dissection was carried down to include skin, subcutaneous fat, and fascia.July 17, 2012 at 11:12 am #55523WorrywartParticipant Congratulations on the good report!July 17, 2012 at 11:47 am #55524Catherine PooleKeymaster It also depends on how conservative the surgeon is. But good question for Dr. Mihm next week.July 17, 2012 at 11:56 am #55525 I think it has been stated on this forum before that it’s “old dogma” thinking to take more tissue?July 18, 2012 at 6:59 am #55526 The surgeon told me he removed tissue down to the muscle layer.
Another interesting thing, my sutures were left in another week, making it three weeks total. The surgeon used a scalpel to open the incision a tiny cut in two places to let it drain. I yelled twice:-)
There exists some controversy about what structures are considered “fascia”, and how fascia should be classified.
1. Superficial fascia
This is found in the subcutis in most regions of the body, blending with the reticular layer of the dermis.
2. Deep fascia
This is the dense fibrous connective tissue that interpenetrates and surrounds the muscles, bones, nerves and blood vessels of the body.
3. Visceral fascia
This suspends the organs within their cavities and wraps them in layers of connective tissue membranes.July 18, 2012 at 7:00 am #55527
Thank you, Worrywart. Your good wishes are much appreciated.
KrisJuly 18, 2012 at 7:10 am #55528
quote Just wondered though was there any particular reason your excision went so deep? My melanoma was 0.72mm and “superficial” Clark 4 and this was excised to a depth of only 1cm compared to your 4cm. Perhaps it all depends on the depth of skin/ fat in the area of the melanoma site…
My surgeon and i discussed how the only successful treatment for melanoma is surgical excision.We agreed he would be aggressive in removing the area. This doc has a stellar reputation. I am a large woman, inactive, 60 yrs old and the melanoma was on my upper back- Those things must factor in. Thank goodness he did the procedure in his office opposed to a surgical center saving me thousands of dollars in debt.
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