Concerning pathology reports for muliple biopsies
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Concerning pathology reports for muliple biopsies

› Forums › General Melanoma Community › Concerning pathology reports for muliple biopsies

  • Post
    • December 1, 2013 at 3:26 pm
    FrankG
    Participant

      I had a stage I melanoma in 2001.  I have had 8 skin biopsies since July, including two basal cells, two benign lesions, and four moles that have been described to me as, "A 9, with 1 as totally benign and 10 as melanoma."  My dermatologist is at Johns Hopkins and really knows his stuff.  I have every confidence in him. Upon reading the path report for the last biopsy, I sent a message to my dermatologist, who replied with the following:

      "I am very perplexed by the pathology results every time I do a biopsy on you.  The reason I have not contacted you yet is because I am asking around pathologists and other physicians if they have come across someone like you, meaning someone who had a melanoma and whose nevi show similar findings to you: lichenoid inflammation, regression changes, melanocyte nesting, intraepidermal atypia and so forth.
      This seems to be the case every time I sample a mole on you.      "

      The "and so forth includes things like nuclear enlargement, prominent nucleoli, dermal fibrosis, numerous colloid bodies, and prominent pigment incontinence.

      The same day I received a call from the resident who did the biopsy with him.  He told me that they had spoken to a number of pathologists and dermatologists at Johns Hoplins and had not found one who had had a similar case. They were particularly concerned that there had been immune responses to each of these dysplastic nevi, which he said does not normally occur.  Subsequently they did a literature seach and found that all cases reported in the literature of immune system responses to non-melanoma nevi were associated with unidentified melanoma elsewhere in the body.

      I have another appointment to discuss nest steps.

      Has anyne had experience or does anyone have knowledge that could be helpful?

       

      Thanks.

       

    Viewing 5 reply threads
    • Replies
        • December 1, 2013 at 5:03 pm
        JC
        Participant

          Wow, this is scary to me because I also had a Stage I melanoma a few years ago, and have had many biopsies since.  All have been benign, but most of the detailed pathology of them has included some of these same terms you mention like “nesting, inflammation, dermal fibrosis” but my derm nor the pathologist ever has seemed concerned about that.

            • December 1, 2013 at 5:16 pm
            Janner
            Participant

              Many of those terms are common in biopsies so don't jump to any conclusions.  Frank's lesions have obviously stood out from the norm of atypical biopsies as something much more unique and not quite understood.

              • December 1, 2013 at 5:16 pm
              Janner
              Participant

                Many of those terms are common in biopsies so don't jump to any conclusions.  Frank's lesions have obviously stood out from the norm of atypical biopsies as something much more unique and not quite understood.

                • December 1, 2013 at 5:16 pm
                Janner
                Participant

                  Many of those terms are common in biopsies so don't jump to any conclusions.  Frank's lesions have obviously stood out from the norm of atypical biopsies as something much more unique and not quite understood.

                  • December 1, 2013 at 5:23 pm
                  FrankG
                  Participant

                    Thanks for your response. I think one of the key elements is the term "regression," but the combination of everything is important as well.  The resident did say that just because the literature does not include cases where melanoma was not foung elsewhere does not mean that there are not such cases.  Uneventful cases tend not to be reported.

                    • December 1, 2013 at 5:23 pm
                    FrankG
                    Participant

                      Thanks for your response. I think one of the key elements is the term "regression," but the combination of everything is important as well.  The resident did say that just because the literature does not include cases where melanoma was not foung elsewhere does not mean that there are not such cases.  Uneventful cases tend not to be reported.

                      • December 1, 2013 at 5:23 pm
                      FrankG
                      Participant

                        Thanks for your response. I think one of the key elements is the term "regression," but the combination of everything is important as well.  The resident did say that just because the literature does not include cases where melanoma was not foung elsewhere does not mean that there are not such cases.  Uneventful cases tend not to be reported.

                      • December 1, 2013 at 5:03 pm
                      JC
                      Participant

                        Wow, this is scary to me because I also had a Stage I melanoma a few years ago, and have had many biopsies since.  All have been benign, but most of the detailed pathology of them has included some of these same terms you mention like “nesting, inflammation, dermal fibrosis” but my derm nor the pathologist ever has seemed concerned about that.

                        • December 1, 2013 at 5:03 pm
                        JC
                        Participant

                          Wow, this is scary to me because I also had a Stage I melanoma a few years ago, and have had many biopsies since.  All have been benign, but most of the detailed pathology of them has included some of these same terms you mention like “nesting, inflammation, dermal fibrosis” but my derm nor the pathologist ever has seemed concerned about that.

                          • December 1, 2013 at 5:11 pm
                          Janner
                          Participant

                            Hi Frank,

                            Sorry to see you are posting again.  Wish I had some words of wisdom for you but I don't.  No clue what they are going to recommend.  I think I might consider sending the slides to some other large institution just for a different reading from people unassociated with JH.  I know my doc really respects Boris Bastian at UCSF but anywhere might be good.  But maybe sending it elsewhere will elicit other opinions on this particular type of lesion.  It sounds as if they might consider doing some other diagnostic procedures to see if there is anything else going on.  Hopefully, this is just something "unique" to you and not indicative of something more sinister.  Keep us updated!

                            Janner

                              • December 1, 2013 at 7:16 pm
                              FrankG
                              Participant

                                Thanks, Jan. 

                                I'm pretty confident in the demertalogist I am now seeing.  I had been going to Roswell Park in Buffalo when we lived in New York State.  I had a complete skin exam in April and specifically asked about one of the moles recently biopsied.  I was told by the PA doing the exam that she was "not concerned."  At least 3 of the 4 moles I have since had biopsied and both of the basal cell carcinomas were present at that time.  The guy I have been seeing since we moved to Marylandhas been very thorough, very cautious, and very tenacious in trying to understand a pattern that he and numerous colleagues have not encountered before.  Three of the biopsies were examined by a quality insurance committee in which several Hopkins pathologists review the findings of the original pathologist.  I will keep Dr Bastian on my list of possibles, but I think I am getting pretty thorough work from the Hopkins people.

                                Regarding uniqueness, my wife says that I have always been weird, and that even my abnormal results are not aren't the abnormal results a normal person gets.

                                 

                                Frank

                                • December 11, 2013 at 8:42 am
                                Kim K
                                Participant

                                  Good to see you posting again!  The reason on the other hand sucks.  I am with Janner on this one, if someone had to be unique, it had to be you!  I am glad you are working with a good team.  Heck, someone has to celebrate being outside the Bell curve, might as well be you.

                                  Did the research paper mention where the sneaky mets were hiding causing such a systemic reaction, or what the tumor burden was?  I know there can be different types of mel that are on the fringe like desmoplastic and some of the spindle cell versions.  Is this somehow related, or are you going to wind up being a good test case for presentation at the next ASCO conference?

                                  Hopefully you are just weird and your immune system is keeping things in check, not the latter.

                                  Take care, good to see you post.

                                  • December 11, 2013 at 8:42 am
                                  Kim K
                                  Participant

                                    Good to see you posting again!  The reason on the other hand sucks.  I am with Janner on this one, if someone had to be unique, it had to be you!  I am glad you are working with a good team.  Heck, someone has to celebrate being outside the Bell curve, might as well be you.

                                    Did the research paper mention where the sneaky mets were hiding causing such a systemic reaction, or what the tumor burden was?  I know there can be different types of mel that are on the fringe like desmoplastic and some of the spindle cell versions.  Is this somehow related, or are you going to wind up being a good test case for presentation at the next ASCO conference?

                                    Hopefully you are just weird and your immune system is keeping things in check, not the latter.

                                    Take care, good to see you post.

                                    • December 11, 2013 at 8:42 am
                                    Kim K
                                    Participant

                                      Good to see you posting again!  The reason on the other hand sucks.  I am with Janner on this one, if someone had to be unique, it had to be you!  I am glad you are working with a good team.  Heck, someone has to celebrate being outside the Bell curve, might as well be you.

                                      Did the research paper mention where the sneaky mets were hiding causing such a systemic reaction, or what the tumor burden was?  I know there can be different types of mel that are on the fringe like desmoplastic and some of the spindle cell versions.  Is this somehow related, or are you going to wind up being a good test case for presentation at the next ASCO conference?

                                      Hopefully you are just weird and your immune system is keeping things in check, not the latter.

                                      Take care, good to see you post.

                                      • December 1, 2013 at 7:16 pm
                                      FrankG
                                      Participant

                                        Thanks, Jan. 

                                        I'm pretty confident in the demertalogist I am now seeing.  I had been going to Roswell Park in Buffalo when we lived in New York State.  I had a complete skin exam in April and specifically asked about one of the moles recently biopsied.  I was told by the PA doing the exam that she was "not concerned."  At least 3 of the 4 moles I have since had biopsied and both of the basal cell carcinomas were present at that time.  The guy I have been seeing since we moved to Marylandhas been very thorough, very cautious, and very tenacious in trying to understand a pattern that he and numerous colleagues have not encountered before.  Three of the biopsies were examined by a quality insurance committee in which several Hopkins pathologists review the findings of the original pathologist.  I will keep Dr Bastian on my list of possibles, but I think I am getting pretty thorough work from the Hopkins people.

                                        Regarding uniqueness, my wife says that I have always been weird, and that even my abnormal results are not aren't the abnormal results a normal person gets.

                                         

                                        Frank

                                        • December 1, 2013 at 7:16 pm
                                        FrankG
                                        Participant

                                          Thanks, Jan. 

                                          I'm pretty confident in the demertalogist I am now seeing.  I had been going to Roswell Park in Buffalo when we lived in New York State.  I had a complete skin exam in April and specifically asked about one of the moles recently biopsied.  I was told by the PA doing the exam that she was "not concerned."  At least 3 of the 4 moles I have since had biopsied and both of the basal cell carcinomas were present at that time.  The guy I have been seeing since we moved to Marylandhas been very thorough, very cautious, and very tenacious in trying to understand a pattern that he and numerous colleagues have not encountered before.  Three of the biopsies were examined by a quality insurance committee in which several Hopkins pathologists review the findings of the original pathologist.  I will keep Dr Bastian on my list of possibles, but I think I am getting pretty thorough work from the Hopkins people.

                                          Regarding uniqueness, my wife says that I have always been weird, and that even my abnormal results are not aren't the abnormal results a normal person gets.

                                           

                                          Frank

                                        • December 1, 2013 at 5:11 pm
                                        Janner
                                        Participant

                                          Hi Frank,

                                          Sorry to see you are posting again.  Wish I had some words of wisdom for you but I don't.  No clue what they are going to recommend.  I think I might consider sending the slides to some other large institution just for a different reading from people unassociated with JH.  I know my doc really respects Boris Bastian at UCSF but anywhere might be good.  But maybe sending it elsewhere will elicit other opinions on this particular type of lesion.  It sounds as if they might consider doing some other diagnostic procedures to see if there is anything else going on.  Hopefully, this is just something "unique" to you and not indicative of something more sinister.  Keep us updated!

                                          Janner

                                          • December 1, 2013 at 5:11 pm
                                          Janner
                                          Participant

                                            Hi Frank,

                                            Sorry to see you are posting again.  Wish I had some words of wisdom for you but I don't.  No clue what they are going to recommend.  I think I might consider sending the slides to some other large institution just for a different reading from people unassociated with JH.  I know my doc really respects Boris Bastian at UCSF but anywhere might be good.  But maybe sending it elsewhere will elicit other opinions on this particular type of lesion.  It sounds as if they might consider doing some other diagnostic procedures to see if there is anything else going on.  Hopefully, this is just something "unique" to you and not indicative of something more sinister.  Keep us updated!

                                            Janner

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