2 Different Path Reports for Stage I

I certainly have had somewhat this experience myself (few years ago).  I obtained 5 different pathology opinions, some said radial growth phase, some said vertical, some didn’t report growth phase.  Those that said vertical did so for different reasons, one due to nest size, one due to dermal mitotic figure.  Some said no mitosis, some said 1, some said less than 1.  Pathology definitely is not cut & dry, black or white – there is judgment, interpretation, etc…they don’t always agree.  They all agreed pretty much on Breslow, but varying opinions on growth phase and mitotic figure (they could not be sure if it was a nevus cell or a melanoma cell with the dermal mitotic figure). 

I certainly have had somewhat this experience myself (few years ago).  I obtained 5 different pathology opinions, some said radial growth phase, some said vertical, some didn’t report growth phase.  Those that said vertical did so for different reasons, one due to nest size, one due to dermal mitotic figure.  Some said no mitosis, some said 1, some said less than 1.  Pathology definitely is not cut & dry, black or white – there is judgment, interpretation, etc…they don’t always agree.  They all agreed pretty much on Breslow, but varying opinions on growth phase and mitotic figure (they could not be sure if it was a nevus cell or a melanoma cell with the dermal mitotic figure). 

I certainly have had somewhat this experience myself (few years ago).  I obtained 5 different pathology opinions, some said radial growth phase, some said vertical, some didn’t report growth phase.  Those that said vertical did so for different reasons, one due to nest size, one due to dermal mitotic figure.  Some said no mitosis, some said 1, some said less than 1.  Pathology definitely is not cut & dry, black or white – there is judgment, interpretation, etc…they don’t always agree.  They all agreed pretty much on Breslow, but varying opinions on growth phase and mitotic figure (they could not be sure if it was a nevus cell or a melanoma cell with the dermal mitotic figure). 

Were both reports written by dermatopathologists?  A general pathologist can create a report, but it is unlikely to be as accurate as a dermatopathologists report.  One specializes in all tissue pathology, the other specializes in skin pathology only.

Pathology is an art as much as a science and you are unlikely to ever have two reports match.  Since your husband has already had all the treament needed, there is really no point in going there.  I understand the "need to know", but this isn't something that has an absolute answer. 

You don't list a breslow for the second report.  Radial growth is most common in in situ, not as common in a deeper lesion.  Clark's Level is very subjective.  Mitosis may be that one path looks at one slide and another path looks at a different slide and sees more/less cell division.  Again, neither may be wrong, but just not looking at the exact same slide. 

Were both reports written by dermatopathologists?  A general pathologist can create a report, but it is unlikely to be as accurate as a dermatopathologists report.  One specializes in all tissue pathology, the other specializes in skin pathology only.

Pathology is an art as much as a science and you are unlikely to ever have two reports match.  Since your husband has already had all the treament needed, there is really no point in going there.  I understand the "need to know", but this isn't something that has an absolute answer. 

You don't list a breslow for the second report.  Radial growth is most common in in situ, not as common in a deeper lesion.  Clark's Level is very subjective.  Mitosis may be that one path looks at one slide and another path looks at a different slide and sees more/less cell division.  Again, neither may be wrong, but just not looking at the exact same slide. 

Were both reports written by dermatopathologists?  A general pathologist can create a report, but it is unlikely to be as accurate as a dermatopathologists report.  One specializes in all tissue pathology, the other specializes in skin pathology only.

Pathology is an art as much as a science and you are unlikely to ever have two reports match.  Since your husband has already had all the treament needed, there is really no point in going there.  I understand the "need to know", but this isn't something that has an absolute answer. 

You don't list a breslow for the second report.  Radial growth is most common in in situ, not as common in a deeper lesion.  Clark's Level is very subjective.  Mitosis may be that one path looks at one slide and another path looks at a different slide and sees more/less cell division.  Again, neither may be wrong, but just not looking at the exact same slide. 

I had a similar experience, my oncologist asked for a second pathology reding as the first gave mitosis reading as low and he wanted a judgment on whether it was 0 or 1. Also he wanted a reading from the lab he regularly used which specializes in Melanoma. The two reports were similar (depth slightly different 0.27 vs 0.30) but the second came down on the side of mitosis zero. There is a great deal of judgment call behind the path report and it seems to me that your first lab (perhaps not used to seeing melanoma everyday?) decided to be more conservative.

Ultimately it does not matter which was "right", your husband is doing the right thing by being vigilant with regular follow ups with dermatologist and oncologist (I'm down to an annual check-up but it's been longer for me). Try not to worry about it – I know that is the hard part!

I had a similar experience, my oncologist asked for a second pathology reding as the first gave mitosis reading as low and he wanted a judgment on whether it was 0 or 1. Also he wanted a reading from the lab he regularly used which specializes in Melanoma. The two reports were similar (depth slightly different 0.27 vs 0.30) but the second came down on the side of mitosis zero. There is a great deal of judgment call behind the path report and it seems to me that your first lab (perhaps not used to seeing melanoma everyday?) decided to be more conservative.

Ultimately it does not matter which was "right", your husband is doing the right thing by being vigilant with regular follow ups with dermatologist and oncologist (I'm down to an annual check-up but it's been longer for me). Try not to worry about it – I know that is the hard part!

I had a similar experience, my oncologist asked for a second pathology reding as the first gave mitosis reading as low and he wanted a judgment on whether it was 0 or 1. Also he wanted a reading from the lab he regularly used which specializes in Melanoma. The two reports were similar (depth slightly different 0.27 vs 0.30) but the second came down on the side of mitosis zero. There is a great deal of judgment call behind the path report and it seems to me that your first lab (perhaps not used to seeing melanoma everyday?) decided to be more conservative.

Ultimately it does not matter which was "right", your husband is doing the right thing by being vigilant with regular follow ups with dermatologist and oncologist (I'm down to an annual check-up but it's been longer for me). Try not to worry about it – I know that is the hard part!