› Forums › General Melanoma Community › HELP me understand my pathology report please
- This topic has 22 replies, 4 voices, and was last updated 7 years, 11 months ago by
YVAN.
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- November 8, 2016 at 4:50 am
Doctor has told me that I have a melonoma in situ. The pathology report diagnosis does say in situ, however it list the pathologic stage as pT1a. So am I in situ or stage 1? The following is the info on the report. Thanks so much for any help with this.
Final microscopic diagnosis: Melanoma; the in situ component extends to the tissue edge.
Type: superficial spreading
Tumor Breslow thickness: 0.35mm
Anatomic level of invasion: Clark level lll
Ulceration: absent
Dermal mitotic rate (mitosis/mm2): 0
Microsatellitosis: none identified
Vertical growth phase: absent
Regression: absent
Angiolymphatic invasion: not identified
Neurotropism: not identified
Tumor infiltrating lymphocytes: non brisk
Precursor lesion: none identified
Pathologic stage: pT1a
comment: sections show a proliferation of atypical melanocytes in the epidermis and dermis. The junctional component is disposed in a confluent fashion with pagetoid upward scatter. The dermal component is present in small aggregates and single cells without maturation.
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- November 8, 2016 at 5:07 am
Stage 1a. In situ has no depth and is Clark's Level 1. You have residual in situ at the margins so maybe that is what your doctor is referring to. Another positive factor is the lesion was in radial growth phase. So even though the lesion has depth, it's probably because the mole itself was invasive. Radial growth with depth is considered similar to in situ because the lesion still doesn't have the invasive growth patterns. You obviously need to have wider margins taken. Although this isn't a stage 0 lesion, it is an early stage 1a lesion and still has a very good prognosis.
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- November 8, 2016 at 5:07 am
Stage 1a. In situ has no depth and is Clark's Level 1. You have residual in situ at the margins so maybe that is what your doctor is referring to. Another positive factor is the lesion was in radial growth phase. So even though the lesion has depth, it's probably because the mole itself was invasive. Radial growth with depth is considered similar to in situ because the lesion still doesn't have the invasive growth patterns. You obviously need to have wider margins taken. Although this isn't a stage 0 lesion, it is an early stage 1a lesion and still has a very good prognosis.
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- November 8, 2016 at 7:28 am
It is definitely a stage 1 melanoma. Anything with a Breslow depth is no longer just in situ. It is a stage 1 melanoma with part of it in situ – that is, part of it (but not all of it) is confined to the epidermis or very top layer of skin, and part of in has invaded the dermis. The in situ part – the part in the epidermis – extends right to the edge of the biopsy taken so that biopsy was not quite complete, some in situ cells were probably left behind. The wide level excision (WLE) of 1cm all around the biopsy site will take care of those. It's an early, thin melanoma with no worrying features like ulceration or mitosis. Get it out and you are done! Six monthly skin checks though… that invasive component (in the dermis) now creates a tiny chance of recurrence or spread.
PS radial means growing outward eg a freckle spreading outward across the skin. You could have a huge spreading melanoma confined to the outward layer of the skin and that wouldn't be such a big deal, it's stuck in the top layer and cannot really spread. However, once it has gone into a vertical growth phase, downward through different layers of the skin, it can come into contact with lymph or blood and spread to other places. In short, radial is the better option.
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- November 8, 2016 at 7:28 am
It is definitely a stage 1 melanoma. Anything with a Breslow depth is no longer just in situ. It is a stage 1 melanoma with part of it in situ – that is, part of it (but not all of it) is confined to the epidermis or very top layer of skin, and part of in has invaded the dermis. The in situ part – the part in the epidermis – extends right to the edge of the biopsy taken so that biopsy was not quite complete, some in situ cells were probably left behind. The wide level excision (WLE) of 1cm all around the biopsy site will take care of those. It's an early, thin melanoma with no worrying features like ulceration or mitosis. Get it out and you are done! Six monthly skin checks though… that invasive component (in the dermis) now creates a tiny chance of recurrence or spread.
PS radial means growing outward eg a freckle spreading outward across the skin. You could have a huge spreading melanoma confined to the outward layer of the skin and that wouldn't be such a big deal, it's stuck in the top layer and cannot really spread. However, once it has gone into a vertical growth phase, downward through different layers of the skin, it can come into contact with lymph or blood and spread to other places. In short, radial is the better option.
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- November 8, 2016 at 2:32 pm
Thanks so much for answering. If there was depth to part of it then wouldn't there also be a vertical? A shave biopsy was done, then the WLE. Should I be concerned about the depth? Will the biopsy or WLE show that the depth was also excised? Sorry for all the questions, but thank you for talking with me. Im going back for my f/up from the WLE on 11/15 and will be able to talk to the dr more then. Im just concerned that he told me I have melanoma in situ and never said anything about the stage 1 part. I caught that myself in reading the report. Also, regarding the comment on the report, is that a description of what was seen in the epidermis and dermis? And why does that not mention melanoma? Just mentions atypical melanocytes and single cells. Thanks!
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- November 8, 2016 at 2:32 pm
Thanks so much for answering. If there was depth to part of it then wouldn't there also be a vertical? A shave biopsy was done, then the WLE. Should I be concerned about the depth? Will the biopsy or WLE show that the depth was also excised? Sorry for all the questions, but thank you for talking with me. Im going back for my f/up from the WLE on 11/15 and will be able to talk to the dr more then. Im just concerned that he told me I have melanoma in situ and never said anything about the stage 1 part. I caught that myself in reading the report. Also, regarding the comment on the report, is that a description of what was seen in the epidermis and dermis? And why does that not mention melanoma? Just mentions atypical melanocytes and single cells. Thanks!
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- November 8, 2016 at 2:46 pm
In reading some of the post here I see some concern over shave biopsys and if the depth measurement was correct or not. Mine was a shave biopsy and was quadrasected. The description reads "a flat piece of skin measuring 1.2 x 0.8 x 0.1 cm with an off centered brown patch measuring 0.7 x 0.5 cm quadrasected and entirely submitted in one cassette. Due to loss of elastic tension and tissue shrinkage in formulin, the clinical sizes may be larger than those reported here."
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- November 8, 2016 at 2:46 pm
In reading some of the post here I see some concern over shave biopsys and if the depth measurement was correct or not. Mine was a shave biopsy and was quadrasected. The description reads "a flat piece of skin measuring 1.2 x 0.8 x 0.1 cm with an off centered brown patch measuring 0.7 x 0.5 cm quadrasected and entirely submitted in one cassette. Due to loss of elastic tension and tissue shrinkage in formulin, the clinical sizes may be larger than those reported here."
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- November 8, 2016 at 2:46 pm
In reading some of the post here I see some concern over shave biopsys and if the depth measurement was correct or not. Mine was a shave biopsy and was quadrasected. The description reads "a flat piece of skin measuring 1.2 x 0.8 x 0.1 cm with an off centered brown patch measuring 0.7 x 0.5 cm quadrasected and entirely submitted in one cassette. Due to loss of elastic tension and tissue shrinkage in formulin, the clinical sizes may be larger than those reported here."
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- November 8, 2016 at 9:04 pm
Growth phase is a more recent anatomical description. It use to be thought that once a lesion had a depth, it was in vertical growth phase. Now, they are looking at things with more nuances. Most moles are confined to the epidermis, but some moles actually penetrate the dermis. So it is possible your melanoma occurred in a deeper mole. So while the melanoma has a depth below the epidermis, the growth pattern is similar to what is seen in in situ lesions on the epidermis. Growth radiating out horzontally and not with the same characteristics of true vertical growth.
Shave biopsies are ony problematic if the shave doesn't go deep enough – bisects the lesion. Nothing in your report says there residual melanoma at the base, only on the side. I don't think you need to worry about the shave biopsy.
Melanoma cells are atypical melanocytes that have specific growth patterns. The description is just pathology speak to justify the diagnosis.
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- November 8, 2016 at 9:04 pm
Growth phase is a more recent anatomical description. It use to be thought that once a lesion had a depth, it was in vertical growth phase. Now, they are looking at things with more nuances. Most moles are confined to the epidermis, but some moles actually penetrate the dermis. So it is possible your melanoma occurred in a deeper mole. So while the melanoma has a depth below the epidermis, the growth pattern is similar to what is seen in in situ lesions on the epidermis. Growth radiating out horzontally and not with the same characteristics of true vertical growth.
Shave biopsies are ony problematic if the shave doesn't go deep enough – bisects the lesion. Nothing in your report says there residual melanoma at the base, only on the side. I don't think you need to worry about the shave biopsy.
Melanoma cells are atypical melanocytes that have specific growth patterns. The description is just pathology speak to justify the diagnosis.
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- September 22, 2017 at 11:37 am
My report mentions a stage1A melanoma 0,3mm after the puch biopsy (all the rest is good: no ulceration, no regression, mitotic rate=0, noxyz, etc…. But it mentions also atypical melanocytes at the margins…. I thus go for a wide excision…But my questions are:
(1) Are atypical myelanocytes at the margins = melanoma…Are these already tumor or only susceptible to become melanoma tumor (??)… My doctor's answer is not clear…..
(2) I bleeded a lot after puch biopsy…if atypical myelanocytes at the margins were indeed already cancer, could they have spread in the blood (??)
YVAN, an anxious patient…
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- November 8, 2016 at 9:04 pm
Growth phase is a more recent anatomical description. It use to be thought that once a lesion had a depth, it was in vertical growth phase. Now, they are looking at things with more nuances. Most moles are confined to the epidermis, but some moles actually penetrate the dermis. So it is possible your melanoma occurred in a deeper mole. So while the melanoma has a depth below the epidermis, the growth pattern is similar to what is seen in in situ lesions on the epidermis. Growth radiating out horzontally and not with the same characteristics of true vertical growth.
Shave biopsies are ony problematic if the shave doesn't go deep enough – bisects the lesion. Nothing in your report says there residual melanoma at the base, only on the side. I don't think you need to worry about the shave biopsy.
Melanoma cells are atypical melanocytes that have specific growth patterns. The description is just pathology speak to justify the diagnosis.
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- November 8, 2016 at 2:32 pm
Thanks so much for answering. If there was depth to part of it then wouldn't there also be a vertical? A shave biopsy was done, then the WLE. Should I be concerned about the depth? Will the biopsy or WLE show that the depth was also excised? Sorry for all the questions, but thank you for talking with me. Im going back for my f/up from the WLE on 11/15 and will be able to talk to the dr more then. Im just concerned that he told me I have melanoma in situ and never said anything about the stage 1 part. I caught that myself in reading the report. Also, regarding the comment on the report, is that a description of what was seen in the epidermis and dermis? And why does that not mention melanoma? Just mentions atypical melanocytes and single cells. Thanks!
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- November 8, 2016 at 7:28 am
It is definitely a stage 1 melanoma. Anything with a Breslow depth is no longer just in situ. It is a stage 1 melanoma with part of it in situ – that is, part of it (but not all of it) is confined to the epidermis or very top layer of skin, and part of in has invaded the dermis. The in situ part – the part in the epidermis – extends right to the edge of the biopsy taken so that biopsy was not quite complete, some in situ cells were probably left behind. The wide level excision (WLE) of 1cm all around the biopsy site will take care of those. It's an early, thin melanoma with no worrying features like ulceration or mitosis. Get it out and you are done! Six monthly skin checks though… that invasive component (in the dermis) now creates a tiny chance of recurrence or spread.
PS radial means growing outward eg a freckle spreading outward across the skin. You could have a huge spreading melanoma confined to the outward layer of the skin and that wouldn't be such a big deal, it's stuck in the top layer and cannot really spread. However, once it has gone into a vertical growth phase, downward through different layers of the skin, it can come into contact with lymph or blood and spread to other places. In short, radial is the better option.
-
- November 8, 2016 at 5:07 am
Stage 1a. In situ has no depth and is Clark's Level 1. You have residual in situ at the margins so maybe that is what your doctor is referring to. Another positive factor is the lesion was in radial growth phase. So even though the lesion has depth, it's probably because the mole itself was invasive. Radial growth with depth is considered similar to in situ because the lesion still doesn't have the invasive growth patterns. You obviously need to have wider margins taken. Although this isn't a stage 0 lesion, it is an early stage 1a lesion and still has a very good prognosis.
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