Pathology report and diagnosis?

Nothing about this report says what they removed was melanoma. You never had it biopsied prior to this removal, therefore they could not have known 100% whether this was melanoma, and if it was melanoma, it would clearly state that what they removed was melanoma. It mentions sebhorric keratosis, which can look a lot like melanoma.. so, it sounds like that's what it was. Maybe Janner will chime in with her more extensive knowledge on path reports. My opinion is that it was never melanoma and gives me more reason to not trust that strange tape test.

Nothing about this report says what they removed was melanoma. You never had it biopsied prior to this removal, therefore they could not have known 100% whether this was melanoma, and if it was melanoma, it would clearly state that what they removed was melanoma. It mentions sebhorric keratosis, which can look a lot like melanoma.. so, it sounds like that's what it was. Maybe Janner will chime in with her more extensive knowledge on path reports. My opinion is that it was never melanoma and gives me more reason to not trust that strange tape test.

Nothing about this report says what they removed was melanoma. You never had it biopsied prior to this removal, therefore they could not have known 100% whether this was melanoma, and if it was melanoma, it would clearly state that what they removed was melanoma. It mentions sebhorric keratosis, which can look a lot like melanoma.. so, it sounds like that's what it was. Maybe Janner will chime in with her more extensive knowledge on path reports. My opinion is that it was never melanoma and gives me more reason to not trust that strange tape test.

Hi, so sorry you had to experience that. I would question the Doctor (I know that's hard) and ask if there was a biopsy  performed prior to the surgery. I am unfamiliar with the tape test. I would seek a second opinion and bring your reports. Without knowing the validity of the tape test I would also question his diagnosis of melanoma.  It seems very vague and with no specific criteria-not knowing cell type, pathology, etc. maybe In the he future (and I hope you do not have any other reason for a biopsy)request a regular biopsy and not the tape. 

Good luck and be persistent with the office until it is explained to you. Explain that it's very confusing to you and you want to know if you had melanoma or not. 

Hi, so sorry you had to experience that. I would question the Doctor (I know that's hard) and ask if there was a biopsy  performed prior to the surgery. I am unfamiliar with the tape test. I would seek a second opinion and bring your reports. Without knowing the validity of the tape test I would also question his diagnosis of melanoma.  It seems very vague and with no specific criteria-not knowing cell type, pathology, etc. maybe In the he future (and I hope you do not have any other reason for a biopsy)request a regular biopsy and not the tape. 

Good luck and be persistent with the office until it is explained to you. Explain that it's very confusing to you and you want to know if you had melanoma or not. 

Hi, so sorry you had to experience that. I would question the Doctor (I know that's hard) and ask if there was a biopsy  performed prior to the surgery. I am unfamiliar with the tape test. I would seek a second opinion and bring your reports. Without knowing the validity of the tape test I would also question his diagnosis of melanoma.  It seems very vague and with no specific criteria-not knowing cell type, pathology, etc. maybe In the he future (and I hope you do not have any other reason for a biopsy)request a regular biopsy and not the tape. 

Good luck and be persistent with the office until it is explained to you. Explain that it's very confusing to you and you want to know if you had melanoma or not. 

Ok, there are two things happening here.  When a doc submits a pathology sample, they typically enter an initial diagnosis.  They give the pathologist a starting place on what they suspect and why they took a biopsy in the first place.  Sometimes it says "rule out <insert something here>.  So I suspect the initial diagnosis submitted by your doc was along the lines of "rule out melanoma in situ" ( or melanoma in situ based on the tape test).  It may also say rule out melanoma or rule out atypical nevus.  So that is the clinical diagnosis – what is seen in the clinic and communicated to the pathologist.

Then you have the pathological diagnosis.  What the pathologist really found was a seborrheic keratosis which is more in line with your comments of being there a long time and never changing.  My reaction is that the tape test (insert correct name here) failed to identify a SK.  SK's can look like melanoma from a glance but are typically quite easily identified up close.  They have a different surface structure that makes the fairly identifiable if you know what to look for.  So my non-medical and 4th party diagnosis is that the tape test failed to identify a stable SK – and that's a pretty big fail.  Having to have a biopsy on your face for a stable lesion that shows positive on this test is a big red flag.  Just my 2 cents – probably worth less than that!

I can't explain the "excisions" at the site but given your posts, I'd be a bit wary about all this.  This is one of those times that a partial biopsy might have been in order if you really are removing a large lesion.  Let the pathology (not the tech test) confirm melanoma before removing a large lesion on your face.  Sorry if I sound harsh but I think you got a raw deal.

Ok, there are two things happening here.  When a doc submits a pathology sample, they typically enter an initial diagnosis.  They give the pathologist a starting place on what they suspect and why they took a biopsy in the first place.  Sometimes it says "rule out <insert something here>.  So I suspect the initial diagnosis submitted by your doc was along the lines of "rule out melanoma in situ" ( or melanoma in situ based on the tape test).  It may also say rule out melanoma or rule out atypical nevus.  So that is the clinical diagnosis – what is seen in the clinic and communicated to the pathologist.

Then you have the pathological diagnosis.  What the pathologist really found was a seborrheic keratosis which is more in line with your comments of being there a long time and never changing.  My reaction is that the tape test (insert correct name here) failed to identify a SK.  SK's can look like melanoma from a glance but are typically quite easily identified up close.  They have a different surface structure that makes the fairly identifiable if you know what to look for.  So my non-medical and 4th party diagnosis is that the tape test failed to identify a stable SK – and that's a pretty big fail.  Having to have a biopsy on your face for a stable lesion that shows positive on this test is a big red flag.  Just my 2 cents – probably worth less than that!

I can't explain the "excisions" at the site but given your posts, I'd be a bit wary about all this.  This is one of those times that a partial biopsy might have been in order if you really are removing a large lesion.  Let the pathology (not the tech test) confirm melanoma before removing a large lesion on your face.  Sorry if I sound harsh but I think you got a raw deal.

Ok, there are two things happening here.  When a doc submits a pathology sample, they typically enter an initial diagnosis.  They give the pathologist a starting place on what they suspect and why they took a biopsy in the first place.  Sometimes it says "rule out <insert something here>.  So I suspect the initial diagnosis submitted by your doc was along the lines of "rule out melanoma in situ" ( or melanoma in situ based on the tape test).  It may also say rule out melanoma or rule out atypical nevus.  So that is the clinical diagnosis – what is seen in the clinic and communicated to the pathologist.

Then you have the pathological diagnosis.  What the pathologist really found was a seborrheic keratosis which is more in line with your comments of being there a long time and never changing.  My reaction is that the tape test (insert correct name here) failed to identify a SK.  SK's can look like melanoma from a glance but are typically quite easily identified up close.  They have a different surface structure that makes the fairly identifiable if you know what to look for.  So my non-medical and 4th party diagnosis is that the tape test failed to identify a stable SK – and that's a pretty big fail.  Having to have a biopsy on your face for a stable lesion that shows positive on this test is a big red flag.  Just my 2 cents – probably worth less than that!

I can't explain the "excisions" at the site but given your posts, I'd be a bit wary about all this.  This is one of those times that a partial biopsy might have been in order if you really are removing a large lesion.  Let the pathology (not the tech test) confirm melanoma before removing a large lesion on your face.  Sorry if I sound harsh but I think you got a raw deal.

Part 2 – still angry from part 1.  I'm almost wondering if the pathologist assumed there had been a biopsy because the initial diagnosis stated melanoma in situ and the "excision" info is standard procedure when you expect there was a biopsy.  (Total speculation on that one).  I might consider a second opinion on the pathology just to see if that pathologist said something similar about the excision info.  I would not seek it because I was worried there was melanoma there.  And honestly, I would not allow them to make any decisions based on that test.  (Me, I would find a different doc but you have to do what works for you).  I'm a big "pro-technology" person but it's obvious this test is not widely accepted or used at this point given the lack of input and skepticism seen on this site.   

Part 2 – still angry from part 1.  I'm almost wondering if the pathologist assumed there had been a biopsy because the initial diagnosis stated melanoma in situ and the "excision" info is standard procedure when you expect there was a biopsy.  (Total speculation on that one).  I might consider a second opinion on the pathology just to see if that pathologist said something similar about the excision info.  I would not seek it because I was worried there was melanoma there.  And honestly, I would not allow them to make any decisions based on that test.  (Me, I would find a different doc but you have to do what works for you).  I'm a big "pro-technology" person but it's obvious this test is not widely accepted or used at this point given the lack of input and skepticism seen on this site.   

Part 2 – still angry from part 1.  I'm almost wondering if the pathologist assumed there had been a biopsy because the initial diagnosis stated melanoma in situ and the "excision" info is standard procedure when you expect there was a biopsy.  (Total speculation on that one).  I might consider a second opinion on the pathology just to see if that pathologist said something similar about the excision info.  I would not seek it because I was worried there was melanoma there.  And honestly, I would not allow them to make any decisions based on that test.  (Me, I would find a different doc but you have to do what works for you).  I'm a big "pro-technology" person but it's obvious this test is not widely accepted or used at this point given the lack of input and skepticism seen on this site.   

Sorry this happened to you George, It is highly unorthodox for a patient to undergo a WLE procedure without first having a biopsy sample examined by a Pathologist.  I rarely go more than 6 months without a trip to my Derm and I have never heard of a "patch" test.  You don't mention your age, but I am 74 and have number of SKs and although they look pigmented and "nasty"  they are harmless although they can sometimes bcome inflamed. If you happen to be a senior citizen, older people often develope a usually slow developing type of melanoma called a Lentigo Maligna. These can be flat and rather bland looking and can exist for a long time before eventually progressing much like superficial spreading. Your lesion could have overlapped a benign SK as well.  My first primary was a flat tan macule about the same size as yours. It had been there for years before changing color to a slightly shiney mettalic brassy look. Upon biopsy it was an in-situ SS melanoma, the most common type. It seems highly unlikely that a tape test could have removed all signs of melanoma if there was one. SS melanoma begins as a proliferation of abnormal  melanocytes at and above  the D/E junction. The patch tape would  be unlikely to remove anything but a slight layer on the surface, If melanoma was present there should have been evidence of it found in your WLE, The D/E junction is the dividing point between the epidermis and the dermis. An early SS will show a proliferation  initially along the junction and eventually these increasingly abnormal melanocytes will infiltrate upwards towards the surface of the skin and also spread laterally along the D/E junction. Once they penetrate into the dermis the lesion is no longer in-situ.  I apologize for such a lengthy reply but I don't know your experience level. As my good friend Janner pointed out biopsy first, path report second, then WLE if biopsy is positive. I personnaly would never go back to that doctor again,

Sorry this happened to you George, It is highly unorthodox for a patient to undergo a WLE procedure without first having a biopsy sample examined by a Pathologist.  I rarely go more than 6 months without a trip to my Derm and I have never heard of a "patch" test.  You don't mention your age, but I am 74 and have number of SKs and although they look pigmented and "nasty"  they are harmless although they can sometimes bcome inflamed. If you happen to be a senior citizen, older people often develope a usually slow developing type of melanoma called a Lentigo Maligna. These can be flat and rather bland looking and can exist for a long time before eventually progressing much like superficial spreading. Your lesion could have overlapped a benign SK as well.  My first primary was a flat tan macule about the same size as yours. It had been there for years before changing color to a slightly shiney mettalic brassy look. Upon biopsy it was an in-situ SS melanoma, the most common type. It seems highly unlikely that a tape test could have removed all signs of melanoma if there was one. SS melanoma begins as a proliferation of abnormal  melanocytes at and above  the D/E junction. The patch tape would  be unlikely to remove anything but a slight layer on the surface, If melanoma was present there should have been evidence of it found in your WLE, The D/E junction is the dividing point between the epidermis and the dermis. An early SS will show a proliferation  initially along the junction and eventually these increasingly abnormal melanocytes will infiltrate upwards towards the surface of the skin and also spread laterally along the D/E junction. Once they penetrate into the dermis the lesion is no longer in-situ.  I apologize for such a lengthy reply but I don't know your experience level. As my good friend Janner pointed out biopsy first, path report second, then WLE if biopsy is positive. I personnaly would never go back to that doctor again,

Sorry this happened to you George, It is highly unorthodox for a patient to undergo a WLE procedure without first having a biopsy sample examined by a Pathologist.  I rarely go more than 6 months without a trip to my Derm and I have never heard of a "patch" test.  You don't mention your age, but I am 74 and have number of SKs and although they look pigmented and "nasty"  they are harmless although they can sometimes bcome inflamed. If you happen to be a senior citizen, older people often develope a usually slow developing type of melanoma called a Lentigo Maligna. These can be flat and rather bland looking and can exist for a long time before eventually progressing much like superficial spreading. Your lesion could have overlapped a benign SK as well.  My first primary was a flat tan macule about the same size as yours. It had been there for years before changing color to a slightly shiney mettalic brassy look. Upon biopsy it was an in-situ SS melanoma, the most common type. It seems highly unlikely that a tape test could have removed all signs of melanoma if there was one. SS melanoma begins as a proliferation of abnormal  melanocytes at and above  the D/E junction. The patch tape would  be unlikely to remove anything but a slight layer on the surface, If melanoma was present there should have been evidence of it found in your WLE, The D/E junction is the dividing point between the epidermis and the dermis. An early SS will show a proliferation  initially along the junction and eventually these increasingly abnormal melanocytes will infiltrate upwards towards the surface of the skin and also spread laterally along the D/E junction. Once they penetrate into the dermis the lesion is no longer in-situ.  I apologize for such a lengthy reply but I don't know your experience level. As my good friend Janner pointed out biopsy first, path report second, then WLE if biopsy is positive. I personnaly would never go back to that doctor again,