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Help understanding punch biopsy results
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Help understanding punch biopsy results

› Forums › Cutaneous Melanoma Community › Help understanding punch biopsy results

  • Post
    • March 16, 2018 at 3:56 pm
    samiam
    Participant

      Two weeks ago, I went to my dermatologist for an abnormal mole on my mid-back. I'm a 34 year-old male. The derm did a punch biopsy and the results have come back positive for "malignant melanoma  approximately 0.2 mm in thickness." The notes say "The melanoma is only focally present in the dermis. The lesion extends to the lateral margins." it also says "Abnormal melanocytes disposed as solitary units and in nests are present within the epidermis and the upper part of the dermis"

      Other information from the pathology report:

      Mitoses/mm^2: <1

      Regression: present

      Ulceration, intravascular involvement, satellite metastasis, and neurotropism are all absent. 

      T classification: T1a

      Now, I thought the T1a classification and 0.2mm thickness was relatively good news, but my dermatologist wasn't willing to comment much and said that we still won't know the stage until I get a wide excision (scheduled two weeks from now). I definitely was not getting "good vibes" from her about my outlook, but I may be looking for the worst.

      My questions: Is the stage determination (T1a) from a punch biopsy unreliable? Should I worry that regression is present? Do you see anything else that would cause you to worry about this being more than T1a?

      Thanks for your help in advance.

       

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    • Replies
        • March 16, 2018 at 5:37 pm
        welcome32
        Participant

          Hi Samiam.   Hearing those words "malignant melanoma", I know is very scary.  I am not an expert by any means.  My 24 yr old daugher was diagnosed with melanoma almost 2 years ago.  From what I see there are way more positives in this report then negatives.  0.2mm thickness is good news.  The mitoses less then 1 also good, as well as Ulceration, intravascular involvement, satellite metastasis, and neurotroprism absent, all very positive.  Regression present, in it of itself, at this point I don't think is terrible news at all.  As far as the the stage determination of (T1a) from the punch biopsy sounds right, which is good….You have found a great place to get information…there are many other people on here that hold a lot more information then I and they have helped me along the way…….I wish you the very best!!

            • March 17, 2018 at 1:12 pm
            samiam
            Participant

              Thank You! You've made me feel much better.

            • March 16, 2018 at 11:38 pm
            Janner
            Participant

              I see two issues here.  1, involved lateral margins.  It is possible that the doc didn't get the center of the melanoma.  If it were a particularly large lesion, then a deeper portion could be outside the biopsy.  That is why you have to wait until the wide excision to know more.  The second issue is regression.  Regression is kind of a double-edged sword.  It basically means your body has recognized the lesion and is attempting to destroy it.  However, it does mean that you have a harder time determining how deep the lesion was prior to the body starting to destroy it.  So even the .2mm could have been deeper.  If the pathologist can see clear signs of where the melanoma was, then they will sometimes note that in the pathology.  Given the stage 1a classification by the pathologist, I doubt that regression plays a large negative role.  As for bad vibes, I wouldn't even go there.  You're looking for bad and are probably readingf more into it than is actually there.

                • March 17, 2018 at 1:15 pm
                samiam
                Participant

                  Thank You! I wish my dermatologist had explained this, but I'm very grateful that you were here to step in. I'll do my best to ignore the bad vibes. Thanks again for making this waiting period less torturous. 

                  • March 18, 2018 at 12:00 pm
                  Jamie1960
                  Participant

                    Given the regression, and difficulty in determining maximum depth as noted above, discuss a slightly more aggressive excision with your surgeon; never any harm in this approach.

                    Best wishes for a successful procedure.

                    • March 20, 2018 at 2:21 pm
                    samiam
                    Participant

                      Thanks Jamie1960, I'm going in next week and I will definitely do this.

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