› Forums › General Melanoma Community › Need Help in Understanding my PATH REPORT
- This topic has 21 replies, 5 voices, and was last updated 10 years, 5 months ago by
mizmena.
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- March 23, 2015 at 9:32 pm
I am newly diagnosed and all this terminology is another language for me…please can anyone help me understand. I had a shave biopsy done of a growing mole on my chest thats what this path report is. Today i did another biopsy of my lymph node under my arm waiting on those results. My lymph node is indeed abnormal via ultrasound w/ a 5.8 cm mass.
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- March 23, 2015 at 9:33 pm
Final Dermatopathology ReportFinal Pathologic DiagnosisSKIN, RIGHT CLAVICLE (BIOPSY): INTRADERMAL MELANOMA. THE TUMOR IS TRANSECTED AT THE DEEP SECTION EDGE. (SEE COMMENT).CommentMultiple levels of recut sections have been examined. The sections show a shave biopsy of skin to the level of the mid reticular dermis. The epidermis exhibits atrophy. Intraepidermal tumor is not identified. Within the dermis are large, discrete nodules of tumor displaying prominent epithelioid morphologic features with moderate to marked nuclear pleomorphism and focally prominent nucleoli. The tumor measures at least 2.8 mm from the granular layer of the epidermis. Numerous mitotic figures are present in the neoplastic cells (14 per millimeter squared). A moderate to focally dense lymphoplasmacytic inflammatory infiltrate is admixed within and surrounding the tumor nodules. Immunohistochemistry for S-100 protein and Melan-A is diffusely positive in the tumor cells and staining for cytokeratin (AE1/AE3) is negative in the neoplastic cells. The tumor is transected at the deep section edge.The histopathologic findings show nodules of melanoma diffusely involving the dermis. The differential diagnosis includes primary nodular melanoma, primary dermal melanoma and metastatic melanoma requiring close correlation with the clinical history, clinical presentation and results of imaging studies for distinction. If the tumor is determined to represent a primary melanoma, the following histopathologic parameters apply:Breslow thickness = at least 2.8 mmClark level = at least IVUlceration: absentRegression: PresentMitoses: 14 per millimeter squaredAngiolymphatic invasion: absentPerineural invasion: absentMicroscopic satellites: absentPathologic stage: at least pT3aIn view of transection of the tumor at the deep section edge, the Breslow thickness and Clark level may require revision pending examination of the excision specimen.Close correlation is essential to determine rather this represents a primary or metastatic melanoma.In addition, given the clinical history of recent onset vitiligo and prominent inflammatory response to the tumor, the depigmented areas may represent melanoma-associated vitiligo.The case was discussed with Dr. Rice on 3/17/15.mplclxElectronically Signed by Douglas C. Parker, M.D.3/18/2015 15:49Clinical HistoryRight clavicle. BCC. Biopsy shave. No personal/family history of NMSC/MM.Specimen(s) ReceivedA: Right clavicleGross DescriptionThe specimen is received in formalin and is labeled “right clavicle .” The specimen consists of an ovoid pink-tan skin shave excision measuring 1.6 x 1.3 x 0.5cm. The specimen is trisected and submitted entirely in cassette A1.mplsmp/3/13/2015Microscopic DescriptionMicroscopic examination performed.-
- March 23, 2015 at 9:51 pm
First, I recommend you find a melanoma specialist. Most important thing you can do for yourself.
Your lesion is at least stage II (>2mm) and appears to be growing quickly (mitosis of 14). The shave biopsy cut through the bottom of the lesion so you will never know the true depth. Since you have an enlarged lymph node already, that is worrisome for stage III. Typically, a sentinel lymph node biopsy is done to test for lymph node involvement, but it appears they plan to just biopsy the enlarged node to look for metastatic cells instead. A little outside normal protocol but ok, I suppose. I suspect if the lymph node is positive, they will do some type of scans to determine if it has spread futher than the lymph nodes. Somewhere along the line, you will need to have a larger excision of where the primary tumor was located. They will take out a huge chunk of skin – 2 cm margins all around. To close a large defect like that, a very long incision or a skin graft would be the most likely scenarios. You want someone who is good at this type of surgery taking care of you.
Right now, you are in a state of limbo, because you need to know whether or not that lymph node has melanoma (stage III) and, if positive, that if that is the only location. All this initial staging takes a little time before anyone can consider treatment.
When it comes to possible treatments, though, you really need to talk to a specialist. Melanoma treatment has changed monumentally in the last 2-3 years, and a general oncologist is unlikely to be up on the current strategies. In addition, clinical trials are a very valid option for some stages of melanoma treatment, and general oncologists are unlikely to be very knowledgeable about treatments of that type.
Sorry you have to join us here – there is a lot to take in right up front. Feel free to ask more questions.
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- March 24, 2015 at 4:52 pm
Thank you so much!! I have Pet Scan and MRI scheduled for April 6, I am assuming this is to make sure if it has spread to other areas or not. Patiently awaiting the biopsy of the lymph node results. It was scheudled before the actual lesion biopsy came back because i was complaining of a painful swollen node to my primary care doc and when they did the ultrasound they noticed and abnormality, then two days later the biopsy came back of the lesion positive for melanoma. So rather than me canceling the biopsy since it was scheduled for the next day we moved forward with it.
I have been speaking w/ the melanoma coordinator at WINSHIP Emory and she has been nice, but not very informative. So my emotions are all over the place. Then getting the path report is like an alien language.
Thank you so much for taking the time to help me understand. I am sure as the time passes i will have tons of questions.
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- March 24, 2015 at 4:52 pm
Thank you so much!! I have Pet Scan and MRI scheduled for April 6, I am assuming this is to make sure if it has spread to other areas or not. Patiently awaiting the biopsy of the lymph node results. It was scheudled before the actual lesion biopsy came back because i was complaining of a painful swollen node to my primary care doc and when they did the ultrasound they noticed and abnormality, then two days later the biopsy came back of the lesion positive for melanoma. So rather than me canceling the biopsy since it was scheduled for the next day we moved forward with it.
I have been speaking w/ the melanoma coordinator at WINSHIP Emory and she has been nice, but not very informative. So my emotions are all over the place. Then getting the path report is like an alien language.
Thank you so much for taking the time to help me understand. I am sure as the time passes i will have tons of questions.
-
- March 24, 2015 at 4:52 pm
Thank you so much!! I have Pet Scan and MRI scheduled for April 6, I am assuming this is to make sure if it has spread to other areas or not. Patiently awaiting the biopsy of the lymph node results. It was scheudled before the actual lesion biopsy came back because i was complaining of a painful swollen node to my primary care doc and when they did the ultrasound they noticed and abnormality, then two days later the biopsy came back of the lesion positive for melanoma. So rather than me canceling the biopsy since it was scheduled for the next day we moved forward with it.
I have been speaking w/ the melanoma coordinator at WINSHIP Emory and she has been nice, but not very informative. So my emotions are all over the place. Then getting the path report is like an alien language.
Thank you so much for taking the time to help me understand. I am sure as the time passes i will have tons of questions.
-
- March 23, 2015 at 9:51 pm
First, I recommend you find a melanoma specialist. Most important thing you can do for yourself.
Your lesion is at least stage II (>2mm) and appears to be growing quickly (mitosis of 14). The shave biopsy cut through the bottom of the lesion so you will never know the true depth. Since you have an enlarged lymph node already, that is worrisome for stage III. Typically, a sentinel lymph node biopsy is done to test for lymph node involvement, but it appears they plan to just biopsy the enlarged node to look for metastatic cells instead. A little outside normal protocol but ok, I suppose. I suspect if the lymph node is positive, they will do some type of scans to determine if it has spread futher than the lymph nodes. Somewhere along the line, you will need to have a larger excision of where the primary tumor was located. They will take out a huge chunk of skin – 2 cm margins all around. To close a large defect like that, a very long incision or a skin graft would be the most likely scenarios. You want someone who is good at this type of surgery taking care of you.
Right now, you are in a state of limbo, because you need to know whether or not that lymph node has melanoma (stage III) and, if positive, that if that is the only location. All this initial staging takes a little time before anyone can consider treatment.
When it comes to possible treatments, though, you really need to talk to a specialist. Melanoma treatment has changed monumentally in the last 2-3 years, and a general oncologist is unlikely to be up on the current strategies. In addition, clinical trials are a very valid option for some stages of melanoma treatment, and general oncologists are unlikely to be very knowledgeable about treatments of that type.
Sorry you have to join us here – there is a lot to take in right up front. Feel free to ask more questions.
-
- March 23, 2015 at 9:51 pm
First, I recommend you find a melanoma specialist. Most important thing you can do for yourself.
Your lesion is at least stage II (>2mm) and appears to be growing quickly (mitosis of 14). The shave biopsy cut through the bottom of the lesion so you will never know the true depth. Since you have an enlarged lymph node already, that is worrisome for stage III. Typically, a sentinel lymph node biopsy is done to test for lymph node involvement, but it appears they plan to just biopsy the enlarged node to look for metastatic cells instead. A little outside normal protocol but ok, I suppose. I suspect if the lymph node is positive, they will do some type of scans to determine if it has spread futher than the lymph nodes. Somewhere along the line, you will need to have a larger excision of where the primary tumor was located. They will take out a huge chunk of skin – 2 cm margins all around. To close a large defect like that, a very long incision or a skin graft would be the most likely scenarios. You want someone who is good at this type of surgery taking care of you.
Right now, you are in a state of limbo, because you need to know whether or not that lymph node has melanoma (stage III) and, if positive, that if that is the only location. All this initial staging takes a little time before anyone can consider treatment.
When it comes to possible treatments, though, you really need to talk to a specialist. Melanoma treatment has changed monumentally in the last 2-3 years, and a general oncologist is unlikely to be up on the current strategies. In addition, clinical trials are a very valid option for some stages of melanoma treatment, and general oncologists are unlikely to be very knowledgeable about treatments of that type.
Sorry you have to join us here – there is a lot to take in right up front. Feel free to ask more questions.
-
- March 23, 2015 at 9:33 pm
Final Dermatopathology ReportFinal Pathologic DiagnosisSKIN, RIGHT CLAVICLE (BIOPSY): INTRADERMAL MELANOMA. THE TUMOR IS TRANSECTED AT THE DEEP SECTION EDGE. (SEE COMMENT).CommentMultiple levels of recut sections have been examined. The sections show a shave biopsy of skin to the level of the mid reticular dermis. The epidermis exhibits atrophy. Intraepidermal tumor is not identified. Within the dermis are large, discrete nodules of tumor displaying prominent epithelioid morphologic features with moderate to marked nuclear pleomorphism and focally prominent nucleoli. The tumor measures at least 2.8 mm from the granular layer of the epidermis. Numerous mitotic figures are present in the neoplastic cells (14 per millimeter squared). A moderate to focally dense lymphoplasmacytic inflammatory infiltrate is admixed within and surrounding the tumor nodules. Immunohistochemistry for S-100 protein and Melan-A is diffusely positive in the tumor cells and staining for cytokeratin (AE1/AE3) is negative in the neoplastic cells. The tumor is transected at the deep section edge.The histopathologic findings show nodules of melanoma diffusely involving the dermis. The differential diagnosis includes primary nodular melanoma, primary dermal melanoma and metastatic melanoma requiring close correlation with the clinical history, clinical presentation and results of imaging studies for distinction. If the tumor is determined to represent a primary melanoma, the following histopathologic parameters apply:Breslow thickness = at least 2.8 mmClark level = at least IVUlceration: absentRegression: PresentMitoses: 14 per millimeter squaredAngiolymphatic invasion: absentPerineural invasion: absentMicroscopic satellites: absentPathologic stage: at least pT3aIn view of transection of the tumor at the deep section edge, the Breslow thickness and Clark level may require revision pending examination of the excision specimen.Close correlation is essential to determine rather this represents a primary or metastatic melanoma.In addition, given the clinical history of recent onset vitiligo and prominent inflammatory response to the tumor, the depigmented areas may represent melanoma-associated vitiligo.The case was discussed with Dr. Rice on 3/17/15.mplclxElectronically Signed by Douglas C. Parker, M.D.3/18/2015 15:49Clinical HistoryRight clavicle. BCC. Biopsy shave. No personal/family history of NMSC/MM.Specimen(s) ReceivedA: Right clavicleGross DescriptionThe specimen is received in formalin and is labeled “right clavicle .” The specimen consists of an ovoid pink-tan skin shave excision measuring 1.6 x 1.3 x 0.5cm. The specimen is trisected and submitted entirely in cassette A1.mplsmp/3/13/2015Microscopic DescriptionMicroscopic examination performed. -
- March 23, 2015 at 9:33 pm
Final Dermatopathology ReportFinal Pathologic DiagnosisSKIN, RIGHT CLAVICLE (BIOPSY): INTRADERMAL MELANOMA. THE TUMOR IS TRANSECTED AT THE DEEP SECTION EDGE. (SEE COMMENT).CommentMultiple levels of recut sections have been examined. The sections show a shave biopsy of skin to the level of the mid reticular dermis. The epidermis exhibits atrophy. Intraepidermal tumor is not identified. Within the dermis are large, discrete nodules of tumor displaying prominent epithelioid morphologic features with moderate to marked nuclear pleomorphism and focally prominent nucleoli. The tumor measures at least 2.8 mm from the granular layer of the epidermis. Numerous mitotic figures are present in the neoplastic cells (14 per millimeter squared). A moderate to focally dense lymphoplasmacytic inflammatory infiltrate is admixed within and surrounding the tumor nodules. Immunohistochemistry for S-100 protein and Melan-A is diffusely positive in the tumor cells and staining for cytokeratin (AE1/AE3) is negative in the neoplastic cells. The tumor is transected at the deep section edge.The histopathologic findings show nodules of melanoma diffusely involving the dermis. The differential diagnosis includes primary nodular melanoma, primary dermal melanoma and metastatic melanoma requiring close correlation with the clinical history, clinical presentation and results of imaging studies for distinction. If the tumor is determined to represent a primary melanoma, the following histopathologic parameters apply:Breslow thickness = at least 2.8 mmClark level = at least IVUlceration: absentRegression: PresentMitoses: 14 per millimeter squaredAngiolymphatic invasion: absentPerineural invasion: absentMicroscopic satellites: absentPathologic stage: at least pT3aIn view of transection of the tumor at the deep section edge, the Breslow thickness and Clark level may require revision pending examination of the excision specimen.Close correlation is essential to determine rather this represents a primary or metastatic melanoma.In addition, given the clinical history of recent onset vitiligo and prominent inflammatory response to the tumor, the depigmented areas may represent melanoma-associated vitiligo.The case was discussed with Dr. Rice on 3/17/15.mplclxElectronically Signed by Douglas C. Parker, M.D.3/18/2015 15:49Clinical HistoryRight clavicle. BCC. Biopsy shave. No personal/family history of NMSC/MM.Specimen(s) ReceivedA: Right clavicleGross DescriptionThe specimen is received in formalin and is labeled “right clavicle .” The specimen consists of an ovoid pink-tan skin shave excision measuring 1.6 x 1.3 x 0.5cm. The specimen is trisected and submitted entirely in cassette A1.mplsmp/3/13/2015Microscopic DescriptionMicroscopic examination performed. -
- March 23, 2015 at 11:09 pm
Hi Mizmena, you have been given great advice by Janner. Seek out a good Melanoma specialist asap and as Janner stated, there are great treatment options available. Wishing you the best!!!! Ed
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- March 23, 2015 at 11:09 pm
Hi Mizmena, you have been given great advice by Janner. Seek out a good Melanoma specialist asap and as Janner stated, there are great treatment options available. Wishing you the best!!!! Ed
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- March 23, 2015 at 11:09 pm
Hi Mizmena, you have been given great advice by Janner. Seek out a good Melanoma specialist asap and as Janner stated, there are great treatment options available. Wishing you the best!!!! Ed
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- March 24, 2015 at 2:06 am
Hi
In as much as Emory is a solid institution and Winship is an extremely competent cancer center, you might want to consider exploring centers that specialize in Melanoma. You have Vanderbilt in Nashville, Moffitt in Tampa and others in the Southeast. With your path and the high mitotic rate, having a Melanima center to consult might be of some benefit.
good luck!!
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- March 24, 2015 at 2:06 am
Hi
In as much as Emory is a solid institution and Winship is an extremely competent cancer center, you might want to consider exploring centers that specialize in Melanoma. You have Vanderbilt in Nashville, Moffitt in Tampa and others in the Southeast. With your path and the high mitotic rate, having a Melanima center to consult might be of some benefit.
good luck!!
-
- March 24, 2015 at 2:06 am
Hi
In as much as Emory is a solid institution and Winship is an extremely competent cancer center, you might want to consider exploring centers that specialize in Melanoma. You have Vanderbilt in Nashville, Moffitt in Tampa and others in the Southeast. With your path and the high mitotic rate, having a Melanima center to consult might be of some benefit.
good luck!!
-
- March 25, 2015 at 7:54 am
IMHO, I have been to Winship for melanoma. They also have a strong team. Regardless, see what they have to say. You need to get fully staged first. Then see what they say regarding treatment, you can also then go for a second opinion elsewhere if needed. Get copies of all your path reports, scans etc. Scans can be put on a CD. If you have it in hand and want a second opinion it will save you time running around to collect all that stuff later on.
This site is excellent to get ideas of questions to ask your docs etc. since so many here are on the cutting edge of this disease and are in clinical trials.
Emory has a good team. In Hawaii, Queen's cancer center has oncologists who are very well versed in melanoma yet they arent considered a "melanoma center of excellence". That being said, I was very confident in my treatment team here in Hawaii and both my surgical and medical oncologists are very knowledgeable about the current treatments availibie for this disease. They also have personal relationships with some of the big names in melanoma and collaborate with them.
If a treatment was unable to be done in our state, my doctors know exactly where I could go should I need to. It really boils down to educating yourself as to what is out there so you know what questions to ask, and the give and take relationship you have with your team.
You are in good hands now, get your final staging, then you can ask the qestions what is the best plan for me and why, get a second opinion if you want, pick something you buy into and then think about your back up plans B, C, D etc….
I am worried your tumor seems very deep, is possibly metastatic to an unknown primary, and has a very high mitotic rate. This is one angry mother, so prepare for the worst and hope for the best. You came to the best place to try to wrap your head around this. So sorry you had to join.
Aloha,
Kim
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- March 25, 2015 at 1:38 pm
Thank you so much. I am scheduled for my Scans on April 6 and my first consultation w/ the doctors the following day..these next 12 days are gonna be horrendous for me. I am already showing an abnormal lymph node so yes its very much possible its metastatic which makes me even more nervous. Praying it hasnt traveled farther. I am def preparing my mind for the worse as with any situation. I am def glad that i found this forum it will come as much needed relief with all the questions that are soon to follow. I am also confident in Emory's team. I have already researched the two oncologist i will be meeting with. They seem to be okay. I believe i will be satisfied w/ the level of care they are going to provide me.
🙂 thanks again.
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- March 25, 2015 at 1:38 pm
Thank you so much. I am scheduled for my Scans on April 6 and my first consultation w/ the doctors the following day..these next 12 days are gonna be horrendous for me. I am already showing an abnormal lymph node so yes its very much possible its metastatic which makes me even more nervous. Praying it hasnt traveled farther. I am def preparing my mind for the worse as with any situation. I am def glad that i found this forum it will come as much needed relief with all the questions that are soon to follow. I am also confident in Emory's team. I have already researched the two oncologist i will be meeting with. They seem to be okay. I believe i will be satisfied w/ the level of care they are going to provide me.
🙂 thanks again.
-
- March 25, 2015 at 1:38 pm
Thank you so much. I am scheduled for my Scans on April 6 and my first consultation w/ the doctors the following day..these next 12 days are gonna be horrendous for me. I am already showing an abnormal lymph node so yes its very much possible its metastatic which makes me even more nervous. Praying it hasnt traveled farther. I am def preparing my mind for the worse as with any situation. I am def glad that i found this forum it will come as much needed relief with all the questions that are soon to follow. I am also confident in Emory's team. I have already researched the two oncologist i will be meeting with. They seem to be okay. I believe i will be satisfied w/ the level of care they are going to provide me.
🙂 thanks again.
-
- March 25, 2015 at 7:54 am
IMHO, I have been to Winship for melanoma. They also have a strong team. Regardless, see what they have to say. You need to get fully staged first. Then see what they say regarding treatment, you can also then go for a second opinion elsewhere if needed. Get copies of all your path reports, scans etc. Scans can be put on a CD. If you have it in hand and want a second opinion it will save you time running around to collect all that stuff later on.
This site is excellent to get ideas of questions to ask your docs etc. since so many here are on the cutting edge of this disease and are in clinical trials.
Emory has a good team. In Hawaii, Queen's cancer center has oncologists who are very well versed in melanoma yet they arent considered a "melanoma center of excellence". That being said, I was very confident in my treatment team here in Hawaii and both my surgical and medical oncologists are very knowledgeable about the current treatments availibie for this disease. They also have personal relationships with some of the big names in melanoma and collaborate with them.
If a treatment was unable to be done in our state, my doctors know exactly where I could go should I need to. It really boils down to educating yourself as to what is out there so you know what questions to ask, and the give and take relationship you have with your team.
You are in good hands now, get your final staging, then you can ask the qestions what is the best plan for me and why, get a second opinion if you want, pick something you buy into and then think about your back up plans B, C, D etc….
I am worried your tumor seems very deep, is possibly metastatic to an unknown primary, and has a very high mitotic rate. This is one angry mother, so prepare for the worst and hope for the best. You came to the best place to try to wrap your head around this. So sorry you had to join.
Aloha,
Kim
-
- March 25, 2015 at 7:54 am
IMHO, I have been to Winship for melanoma. They also have a strong team. Regardless, see what they have to say. You need to get fully staged first. Then see what they say regarding treatment, you can also then go for a second opinion elsewhere if needed. Get copies of all your path reports, scans etc. Scans can be put on a CD. If you have it in hand and want a second opinion it will save you time running around to collect all that stuff later on.
This site is excellent to get ideas of questions to ask your docs etc. since so many here are on the cutting edge of this disease and are in clinical trials.
Emory has a good team. In Hawaii, Queen's cancer center has oncologists who are very well versed in melanoma yet they arent considered a "melanoma center of excellence". That being said, I was very confident in my treatment team here in Hawaii and both my surgical and medical oncologists are very knowledgeable about the current treatments availibie for this disease. They also have personal relationships with some of the big names in melanoma and collaborate with them.
If a treatment was unable to be done in our state, my doctors know exactly where I could go should I need to. It really boils down to educating yourself as to what is out there so you know what questions to ask, and the give and take relationship you have with your team.
You are in good hands now, get your final staging, then you can ask the qestions what is the best plan for me and why, get a second opinion if you want, pick something you buy into and then think about your back up plans B, C, D etc….
I am worried your tumor seems very deep, is possibly metastatic to an unknown primary, and has a very high mitotic rate. This is one angry mother, so prepare for the worst and hope for the best. You came to the best place to try to wrap your head around this. So sorry you had to join.
Aloha,
Kim
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Tagged: cutaneous melanoma
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