› Forums › Cutaneous Melanoma Community › Could some one please help me make sense of this pathology report?
- This topic has 3 replies, 2 voices, and was last updated 7 years, 1 month ago by
Julie in SoCal.
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- May 12, 2018 at 5:31 pm
Hello,
First, thank again to all of you. I hope that I can be of comfort and “some” knowledge to future posters as I begin to learn more about this cancer.
im sorry this is so, so long but I am hoping someone can help me get answers to all this verbiage. A long weekend is hard to wait to try to get answers from the Dr. so if anyone can help me-it would be greatly appreciated. Compared to my first pathology report, this one has so much info and I know so little that it’s frustrating and scary.
As I stated, I had a shaved biopsy that came back as malignant melanoma-superficial melanoma of my upper arm-left anterior distal. This was the report.
Breslow thickness-0.5mm
ulceration-not present
regression-not present
mitotic rate-<1 per mm2 (none present)
L/P/A/I-not identified
tumor infilitrating lympocytes-brisk
Associated melanoctytic nevus-not present
deep margin-involved
peripheal margin-involved
Stage-at least T1aNxMx
Next appointment was with a surgical onocologist for a deep punch biopsy and they state that I have caught it early and after I stated I thought I should have a sentinel node biopsy, he thought it was unnecessary.
i kept waiting for my test results. And called the center, which is huge and busy and finally messaged them and found out my results were not in, but would go ahead with the wide excision surgery.
next appointment-one week and a few days later after punch biopsy, I am at the surgical center and the Dr had to call the pathologist for the results which they stated had no residual signs of melanoma present.
so I have the surgical procedure done and then the next day I ask for my pathology report and it states that this is what they have concluded from my FIRST biopsy, not the punch whole biopsy from the surgical onocologist.
this is from the slides of the shaved biopsy from the dermatologist and their interpretation.
if you could help me understand this before I meet with the surgical oncologist in 2 weeks, (I hope to talk to him sooner) I would greatly appreciate it.
microscopic examination:
Sections of specimen A show skin excised to include subcutaneous tissue. Near the center of the specimen, Reyes are effaced with organizing granulation tissue and a patchy chronic inflammatory infiltrate in the underlying dermis. Adjacent to this area, individual and nested atypical melanocytes are present at the dermal-epidermal junction. Scattered atypical melanocytes are present above the basement membrane. A prominent chronic inflamatory infiltrate is presentbin the dermis and makes identification of any possible invasive component to this lesion difficult on hematoxylinand eosin-stained sections. Immunoperixidase staining for HMB-45 is positive for melanocytes at the dermal-epidermal junction, above the basement membrane and Fox ally in adnexal stuctures. Rare HMB-45 positive cells are present in the superficial dermis.
Immunoperoxidase staining for Melan-A and Ki-67 was performed on a single slide cut from block A1. Melan-A is positive for individual and nested melanocytes at the dermal-epidermal junction, above the basement membrane and in adnexal structures. Some background staining is present in the dermis; however, a few melanocytes are present in the inflamed dermis. Immunoperoxidase staining for Ki-67 is positive for the nuclei of basilar keratinocytes as an internal control. Many of the Mela-A positive cells at the dermal-epidermal junction coexpress Ki-67. Occasional Melan-A positive cells in the dermis also stain positive for Ki-67.
Synoptic report:
malignant melanoma
type-compatiable with superficial melanoma
breadth (diameter of lesion) not given
level of invadionClark’s level II-early III
depth of invasion-0.7mm
radial growth phase-not identified
mitotic count-0/mm2
regression-not identified
precursor lesion-not identified
Blood vessel, lymphatic and neural invasion-not identified.
tumor infiltrating lymphocytes: present; brisk
satellite nodule-not identified
margins- the in situ component of this lesion extends to the lateral specimen borders. Melanocytes in the dermis extend to within approximately 4.5mm from the biopsy base.
AJCC pT1a stage lesion
final evaluation of this lesion with respect to prognostic factors would require histology evaluation of the completely excised lesion.
complete excision of this lesion is recommended.
Thank you for taking the time to read this. I don’t take your time and effort for granted.
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- May 12, 2018 at 7:56 pm
Hi Ohio Mom,
Welcome to the group that no one would choose to be in. I myself have found loads of comfort and wisdom here. I trust you will find this here, too.
You path report is a lot to take in and there are folks here that are more knowledgeable about reading a path report than I am. Maybe they will chime in.
But the important bits I read from your path report are that both horizontal and vertical margins were involved. Because the vertical margin was involved you'll never know what the true depth of your lesion was and at this point depth is an important factor. Don't freak out, this is unfortunately fairly common as derms like shave biopsies.
I would talk with my doctor about the rationale for not having a sentinel node biopsy (SNB). As I understand it, your melanoma was at least .7mm deep, and .7 is borderline for a SNB. It's possible there are other factors now in determining this, but I think depth is the most important.
Before you have a Wide Local Excision, talk to your oncologist about the SNB. You should have the SNB before, or at the same time as the WLE as the WLE will mess up the lymph drainage path to the nodes.
Finally, the best advice I was given was to find an oncologist who sees a lot of melanoma. Not just a regular or general oncologist. There has been a lot of new treatments and options in the melanoma treatment world, general oncologists might not know about these. Find someone who does.
If you'd like help finding a Mel Doc, write a separate thread with that in the heading. There are folks here who can give you good recommendations.
I wish you Peace!
Julie
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- May 12, 2018 at 8:46 pm
Thanks Julie,
I already had the WLE, so that scares me.
This is a surgical onocologist who specializes in melanoma.
I had the shaved biopsy and then the punch hole biopsy with no risidual melanoma, And have already had the WLE. Both the punch hole and WLE was performed by the surgical onocologist.
All of the writing/verbiage was from the pathology report that the surgical onocologist had done of the shaved biopsy and I don’t understand most of it.
But thank you for your response and best wishes to you!
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- May 12, 2018 at 9:06 pm
Hi Ohio Mom,
Sorry I missed that!
I was in a similar situation as you, sort of. Rather than shave off my lesion, my derm lasered it off– twice before I was diagnosed (it's a long story). Then I went quickly to a WLE, before the SNB, and both were messed up, so I needed to do it all over again. So I did it all backwards, too. Eventually I did have the SNB and CLND and had mel there, too. So I moved to stage 3.
But I'm still here 10 years later!
So I guess all I"m saying here is that you're in the right place with this, even if things don't go textbook. If you have a good mel doc that you can work with, you're doing the best you can.
Peace to you!
Julie
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Tagged: cutaneous melanoma
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