Home Forums Melanoma Diagnosis: Stages I &II Wide Local Excision Surgical Report

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  • #20487
    krissy424
    Participant

    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 – http://www.ccpathology.com

    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 93401

    #55520
    bon15
    Participant

    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…

    #55521
    cohanja
    Participant

    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.

    #55522
    cohanja
    Participant

    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.

    #55523
    Worrywart
    Participant

    Congratulations on the good report!

    :D

    #55524
    Catherine Poole
    Keymaster

    It also depends on how conservative the surgeon is. But good question for Dr. Mihm next week.

    #55525
    cohanja
    Participant

    I think it has been stated on this forum before that it’s “old dogma” thinking to take more tissue?

    #55526
    krissy424
    Participant

    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:-)

    Fascia

    From Wikipedia

    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.

    http://en.wikipedia.org/wiki/Fascia

    #55527
    krissy424
    Participant

    Thank you, Worrywart. Your good wishes are much appreciated.

    Kris

    #55528
    krissy424
    Participant

    bon15 posted

    Quote:

    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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