› Forums › Cutaneous Melanoma Community › Janner, please help with this path report?
- This topic has 3 replies, 3 voices, and was last updated 7 years, 2 months ago by
BerryTaylor.
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- March 2, 2018 at 2:15 pm
Hi Janner,
I would like to hear your advice here. I got mole removed back in 2015 and pathology report wasn`t excluding early melanoma arising from mole.
I am still being watched by dermatooncologists and go for check ups, however I would like to hear your opinion on my path report and how it should be interpreted. Please see my traslation below, as the report is not in english.
"Micro: Combined dysplastic pigmented nevus with nests of prolifiration of pagetoid cells. Recommended immune staining to exclude intraepidermal superficial spreading melanoma. Recommended stains are Tyrosinasa, HMB-45 , Ki-67.
Immune staining:
Tyrosinase, HMB-45 – bright positive cytoplasmic reaction in the intraepithelial component of proliferating cells with their extension up to the horny layer. In the structure of the intradermal nevus is negative reaction.
Ki-67 – positive nuclear(?) reaction in cells of basal layer in epithelium of epidermis.Conclusion:morphologic features and immunefenotype are matching melanoma arising in a dysplastic nevus"
I had re-excision and it was all clear.
So i have a few questions if you can help me please?
1)This report says just melanoma arising with nevus, but according to immune staining it is in epithelium so looks like in situ, no? why it doesn`t state this then?
2) I believe i don`t have Clark and breslow because first pathologist that did micro considered this a dysplastic nevus with proliferating cell, correct?
3) I am checked up by dermatologist and every time i leave them with a paper it doesn`t say my concrete diagnosis(like in situ), it just has code for skin cancer and in the original diagnosis field they put the whole pathology. Does it mean they don`t consider it full in situ yet?
4) it has been already a few years, but do you think i should re-check the slides with another pathologist? Or this report is stating all needed things?
Thanks a lot!
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- March 2, 2018 at 2:46 pm
1. I cannot explain the final diagnosis, that is for the pathologist to do. There is an interpretation that happens from the slides to the diagnosis and only the pathologist can do that. This is either melanoma in situ or severely atypical.
2. In situ lesions – as well as severely atypical lesions would never list a Breslow and Clark's Level. In situ is always Breslow of 0 and Clark 1 by definition.
3. I can't make that determination but it's unlikely that any description would list in situ or a concrete diagnosis. Even with stuff I see I on my charts, I have a "history of melanoma". It never says a stage or anything like that.
4. I see absolutely no reason to do anything more with your slides. As you said, it's been several years. At most, this was a very early in situ and you've had the excision to remove it. It hasn't grown back in the last 3 years – I'd be moving on and not worrying about it.
Your questions are really better put to your doctor or the pathologist. Since each pathologist has their own style and method of writing reports, it is difficult to know what they normally do for comparison. Pathology reports vary widely across pathologists – I've never seen what I would call some type of standard. However, you now understand that Clarks Level and Breslow are never called out unless you get to a stage I lesion. At the most, this is an early in situ.
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- March 2, 2018 at 3:21 pm
Thank you, Janner.
It doesn`t clearly say in situ, just says melanoma arsing in nevus.
I have an idea to re-check the slides as I am scared to have something worse. Do you think according to the report this is insitu max?
I am going to a big clinic, where you are checked by different docs all the time and whenever I asked them what is the dx, all were saying "looks like just some cells were found, this is a very early thing". Can this be correct?According to immune staining with cells not reaching derma, it shouldn`t be anything worse?
sorry for all the questions. It has been some time ago, more moles removed since then(completely benign), but i am still scared by these stories about early melanomas getting worse, that is why i start panicking and want to re-check my slides.
Do you think this is a proper report?
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- March 28, 2018 at 9:10 pm
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Tagged: cutaneous melanoma
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