› Forums › Cutaneous Melanoma Community › Help with pathology report (severe dysplastic)
- This topic has 5 replies, 2 voices, and was last updated 7 years, 1 month ago by
mwang122.
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- April 17, 2018 at 5:24 pm
Hi Janner and everyone,
I need a little help with my pathology report, I found a mole changing in size in December 2016 and it came back as severe dysplastic. I did second surgery to remove more in Feb,2017. I attached the reports.
Diagnosis: Compound Melanocytlc Proliferation With Severe Dysplasla • Closely Approaching
Peripheral And Deep Margins • See Note . Left TempleNOTE: Based on the severe degree of melanocytlc dysplasla, the proximity of the margins, re-excision Is recommended in order to ensure complete removal.
Gross:Thin, 5×4 mm, tan granular pigmented surface, inked. Bisected, totally submitted. (kg)Microscopic
A disorganized junctional proliferation of melanocytes in a lentiginous growth pattern is present with several junctional nests and severe random cy!ologic atypia. There is no slgnifican1 migration of
melanocytes into higher epidermal levels, and this finding is confirmed with a Melan-A immunostain. Melanin incontinence and inflammation is seen. Aggregates of melanocytes are present within the dermis. The atypical melanocy!es closely approach the peripheral and deep margins.SECOND:
Diagnosis
Biopsy Wound. No Residual Dysplastlc Nevus -Left Temple (lyb)Gross
Oval-shaped, 10x10x5 mm, tan granular surface, It has what appears to be a notch which is placed at 12 o'clock 12 o'clock to 6 o'clock margin is marked with green ink and the remainder is marked with
blue ink. Sectioned from 12 o'clock to 6 o'clock, 4 pieces, totally submitted. (kg)
Microscopic
A poorly circurnscribt,d zun<1 uf dermal fibro,;ls is present with prulife,..ling sl,mder ,md ph.inip fibroblasts arranged in a partially horizontal pattern parallel to the skin ,;urface. There 15 neovascul•uizallon and
chronic inflammation. The overlying epidel'mis is somewhat flattened. No residual dysplas!io nevus is
identified.Since I recently found two more moderate dysplastic moles ( one old mole suddenly getting darker in 2 weeks, the other is new, just a little bit orange than all my other moles, very small 1mm size) and therefore I am so paranoid right now. I am afraid the recision of the severe one may be not enough since it only leaves a 2cm scar on my face especially when I heard it might be hard for pathologist to distinguish severe dysplastic and in-situ MM. I do understand I am now at high risk of developing melanoma later in life since I got 4 dysplastic moles already( 1 severe, 2 moderate and 1 mild) and countless sunburn when I was 13 years old. I am also afraid that in the future, pregnancy will also be a factor of developing melanoma. Can you guys give me some information? By the way, I am 25 and Asian with fair skin,
Thanks
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- April 17, 2018 at 5:34 pm
Sorry, the formatting of the second pathology report is bad. Attached new one here
Oval-shaped, 10x10x5 mm, tan granular surface, It has what appears to be a notch which is placed at 12 o'clock 12 o'clock to 6 o'clock margin is marked with green ink and the remainder is marked with
blue ink. Sectioned from 12 o'clock to 6 o'clock, 4 pieces, totally submitted. (kg)
Microscopic
A poorly circumscribed zone of dermal fibrosis is present with proliferating slender and plump fiberolasts arranged in a partially horizontal pattern paraller to the skin surface. There is neovascularization and chronic inflammation. The overlying epidermis is somewhat flattened. No residual dysplastic nevus is identified. -
- April 17, 2018 at 8:02 pm
Let's make one clarification, you are at "higher" risk, not "high" risk for developing melanoma later – mostly based on the severely atypical lesion, certainly not the mild. Your risk is probably 7-10 times the population who don't have a dysplastic nevus history. But that's not much different from having red hair and freckles or things like that. These types of risks are relative risks, not cummulative. You don't just say you have 3 risk factors and that guaratees you will get melanoma. The question I have is have you been diagnosed with dysplastic nevus syndrome? Hundreds of atypical moles?
Melanoma and pregnancy – lots of conficting info over the years. All you can do is live your life and be very vigilant. I wouldn't let some possible risk of melanoma change my lifetime ambition to be a mother. You haven't been diagnosed and are still unlikely to be. You control what you can, live life, and be vigilant. Anything else lets melanoma win before it's even an issue.
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- April 17, 2018 at 11:03 pm
Thanks for much for your help Janner. No I don’t have a lot of moles maybe 30.All of them are small like 1-2mm. Largest would be the severe one that I cut, like 3.5 mm. I am afraid the doctor did not take enough margin because it was on my face they did not want to leave a huge scar.
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- April 18, 2018 at 12:04 am
They took a 10x10x5 mm sample for the wide excision – that is 5mm margins all around. There was no nevus identified in the sample. To me, this means you have the recommended margins. Melanoma in situ is not often "misdiagnosed" – especially if your pathologist reads a lot of melanoma. It is just that there is a bit of a judgement call on whether something is severely atypical or melanoma in situ. If the experienced pathologist has a question about the final diagnosis, it is usually indicated in the report. Looks to me you have the recommended margins and are good to move on.
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Tagged: cutaneous melanoma
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