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Need help with pathology report- was excision adequate??
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Need help with pathology report- was excision adequate??

› Forums › Cutaneous Melanoma Community › Need help with pathology report- was excision adequate??

  • Post
    • February 18, 2018 at 3:51 pm
    Abul3059
    Participant
      I had an excision of melanoma in situ from my right, mid back, last June 2017. Now there is a purole spot appearing almost exactly where my melanoma was, right in the incision line. I have already contact my dermatologist regarding this. I am wondering if the excision was adequate and will include the report here :

      SKIN, RIGHT MID BACK, REEXCISION
      CLINICAL HISTORY:
      Biopsy proven melanoma in situ 4-0 Vicryl PS2, Prolene PS2
      GROSS DESCRIPTION:
      The specimen is received in a formalin filled container labeled “rt mid back”
      and consists of an unoriented, 2.7 x 1.3 x 1.2 cm, tan-white hair-bearing skin
      ellipse. The cutaneous surface displays an eccentric 0.5 x 0.5 cm previous
      biopsy site that is 0.3 cm from the closest peripheral margin. The deep
      surface is inked black and the specimen is sectioned from tip to tip into nine
      pieces to reveal no obvious mass. (ESB/4B)
      KEY CODE:
      1A first one-third of the specimen, three pieces
      1B-C mid one-third of the specimen containing the previous biopsy site
      1B two full cross sections
      1C one full cross section
      1D remaining one-third of the specimen, three pieces
      No time was given that the specimen was taken from the body or placed in
      fixative. The total elapsed time the specimen was in fixative cannot be
      determined.

      I am concerned about the ‘0.3 cm’ from peripheral margin. In her notes from the procedure, she stated that 9mm margins were measured- how could this be? I had a previous shave biopsy before this excision. Thank you!
      Alyssa

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    • Replies
        • February 18, 2018 at 3:56 pm
        Abul3059
        Participant
          I meant to say a ‘purple’ spot- and it’s maybe 2mm large. I’m hoping it’s just discoloration or a vein. My melanoma was only 1mm-2mm in diameter but very dark.
            • February 19, 2018 at 3:37 am
            Janner
            Participant

              If your biopsy had extra margins, she would be adding what was seen here to the biopsy margins.

              • February 19, 2018 at 4:19 am
              Abul3059
              Participant

                Thank you for your reply. I tried to add up the margins as you indicated but for some reason I'm still not getting 9mm. Here are the biopsy measurements:

                Specimen one is received labeled "mid back" and consists of a tan-white, 0.6 x 0.4 x 0.1 cm shave biopsy with a 0.1 x less than 0.1 cm dark brown macule that is within 0.1 cm of the closest circumferential margin.  The tissue is bisected. 

                I could be doing it wrong, but I just want to make sure the excision was done properly and enough surrounding tissue was removed. Thanks for your help,

                Alyssa 

                • February 24, 2018 at 6:45 am
                Abul3059
                Participant
                  My doc claims the difference in her measurement of 9mm vs the histological margin measurement 3mm is due to shrinkage. I’m still not convinced- studies that I’ve seen don’t report THAT amount of shrinkage. I’m seriously considering re excision by another derm at this point- any other thoughts?? I’m torn on what to do. This is so stressful.
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