› Forums › Cutaneous Melanoma Community › scared!! test results
- This topic has 18 replies, 3 voices, and was last updated 12 years, 7 months ago by
Janner.
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- January 23, 2013 at 7:22 am
Can someone please help what this means. I am so terrified of the results? I had the wide excision
but they only took 5mm and am worried they did not go deep enough eithher. The wle came back ok,
but should i go further and get 9mm?? Is this actually cancer yet?
Can someone please help what this means. I am so terrified of the results? I had the wide excision
but they only took 5mm and am worried they did not go deep enough eithher. The wle came back ok,
but should i go further and get 9mm?? Is this actually cancer yet?
PATIENT HISTORY: (original diagnosis)
Specimen from the (part A) skin
of back, right low, (part B) skin of axilla. Initial pathologic impression is
(part A) Clark's (dysplastic) nevus, compound type, inflamed, unusual with
features of partial regression. Margins negative for lesion.
_______________________________________________________________
FINAL DIAGNOSIS: )after re-review)
1. SKIN, BACK, EXCISION (OSS, S-12-13576 A, 11/02/2012,
MALIGNANT MELANOMA IN-SITU, ARISING IN ASSOCIATION WITH A COMPOUND MELANOCYTIC
NEVUS WITH ARCHITECTURAL DISORDER AND MODERATE TO FOCALLY SEVERE CYTOLOGIC
ATYPIA (aka DYSPLASTIC / CLARK'S NEVUS) (See comment).
COMMENT:
1. Examination of multiple levels reveals a growth of enlarged atypical
melanocytes arranged as single units and as confluent irregular nests at the
dermoepidermal junction and above it. The atypical melanocytes have
pleomorphic and hyperchromatic nuclei and some of them have prominent
nucleoli. Some melanocytes have ample cytoplasm and coarse dendrites. The
atypical junctional melanocytes merge with a second population of melanocytes
arranged as nests at the dermoepidermal junction and mainly as single units in
the dermis. The dermal melanocytes tend to mature with descent, and no
melanoma can be appreciated in the dermis. Interpretation of
immunohistochemical stains (S100, Melan-A, HMB45, and tyrosinase) confirm this
impression. A Ki-67 does not reveal an increase in the proliferative index of
the dermal melanocytes. Since this case was not grossed at our institution, we
hesitate to comment on the final margin status; however, the slide section
margins appear free of melanoma in-situ.
Overall, this is a challenging case, but the amount of confluence and presence
of upward epidermal spread is sufficient for an outright diagnosis of an early
evolving melanoma in-situ. There is a second population of melanocytes in
close approximation to this melanoma that is best categorized as a nevus.
Though slide section margins appear to be free, complete re-excision to ensure
removal and prevent recurrence and/or progression of this lesion is
recommended. This case was also presented at our daily quality assurance
conference and agrees with the interpretation above.
- Replies
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- January 23, 2013 at 2:23 pm
5mm is the standard of care for melanoma in situ. All WLE's take tissue down to the muscle fascia so there is no skin tissue below the lesion left. That is basically what the WLE does. Is this cancer? That is an area of some debate. Because melanoma in situ basically lacks the ability to spread, some schools of thought think it is not cancer. Yours appears to be extremely early — i.e. it is evolving into melanoma in situ as opposed to full blown melanoma in situ. It doesn't really matter what you call it. You've had it removed. The key now is to watch the scar for any pigment regrowth. As well, watch for any other changing moles. Most don't ever have more than one melanoma primary, but you should pay attention to all your skin and practice sun safety.
Best wishes,
Janner
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- January 23, 2013 at 2:23 pm
5mm is the standard of care for melanoma in situ. All WLE's take tissue down to the muscle fascia so there is no skin tissue below the lesion left. That is basically what the WLE does. Is this cancer? That is an area of some debate. Because melanoma in situ basically lacks the ability to spread, some schools of thought think it is not cancer. Yours appears to be extremely early — i.e. it is evolving into melanoma in situ as opposed to full blown melanoma in situ. It doesn't really matter what you call it. You've had it removed. The key now is to watch the scar for any pigment regrowth. As well, watch for any other changing moles. Most don't ever have more than one melanoma primary, but you should pay attention to all your skin and practice sun safety.
Best wishes,
Janner
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- January 23, 2013 at 2:23 pm
5mm is the standard of care for melanoma in situ. All WLE's take tissue down to the muscle fascia so there is no skin tissue below the lesion left. That is basically what the WLE does. Is this cancer? That is an area of some debate. Because melanoma in situ basically lacks the ability to spread, some schools of thought think it is not cancer. Yours appears to be extremely early — i.e. it is evolving into melanoma in situ as opposed to full blown melanoma in situ. It doesn't really matter what you call it. You've had it removed. The key now is to watch the scar for any pigment regrowth. As well, watch for any other changing moles. Most don't ever have more than one melanoma primary, but you should pay attention to all your skin and practice sun safety.
Best wishes,
Janner
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- January 23, 2013 at 2:42 pm
doesn't invasive radial growth phase also supposedly lack the ability to spread? but they definitely still call that cancer
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- January 23, 2013 at 3:05 pm
Invasive radial growth is stage IA, not stage 0. That's not the same thing. Any depth means it isn't melanoma in situ. Yes, radial growth phase has a better prognosis than vertical growth phase, but it is not confined to the epidermis. That designation is "new" in pathology terms and growth phase is not called out in all lesions, yet. I think a few years will have to pass before the real stats on that particular attribute are accepted.
It is thought that melanoma in situ might be over diagnosed — pathologists erring on the side of "melanoma" versus "atypical" to cover themselves. The incidence of melanoma in situ has risen dramatically, but the stats for all other stages has not changed comparably. As this poster's path report showed, this is "early" and "evolving" which may leave this lesion open to interpretation. A different pathologist might classify this differently. One designation they use for Lentigo Maligna / Lentigo Maligna Melanoma is that it is not called Lentigo Maligna Melanoma until it becomes invasive. It is Lentigo Maligna when in situ. Obviously, that is only one subtype of melanoma, but it is distinguished differently and not called "melanoma" until it becomes invasive.
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- January 23, 2013 at 3:05 pm
Invasive radial growth is stage IA, not stage 0. That's not the same thing. Any depth means it isn't melanoma in situ. Yes, radial growth phase has a better prognosis than vertical growth phase, but it is not confined to the epidermis. That designation is "new" in pathology terms and growth phase is not called out in all lesions, yet. I think a few years will have to pass before the real stats on that particular attribute are accepted.
It is thought that melanoma in situ might be over diagnosed — pathologists erring on the side of "melanoma" versus "atypical" to cover themselves. The incidence of melanoma in situ has risen dramatically, but the stats for all other stages has not changed comparably. As this poster's path report showed, this is "early" and "evolving" which may leave this lesion open to interpretation. A different pathologist might classify this differently. One designation they use for Lentigo Maligna / Lentigo Maligna Melanoma is that it is not called Lentigo Maligna Melanoma until it becomes invasive. It is Lentigo Maligna when in situ. Obviously, that is only one subtype of melanoma, but it is distinguished differently and not called "melanoma" until it becomes invasive.
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- January 23, 2013 at 3:39 pm
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- January 23, 2013 at 3:39 pm
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- January 23, 2013 at 5:20 pm
I've seen this, but that still doesn't mean pathologists regularly call out growth phase. It isn't universal….yet! And if it is truly a telling piece of evidence, it will likely be incorporated into future staging. That's how all the staging factors came about. Additional research showed they were significant and telling in prognosis so they were adopted as part of the staging criteria.
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- January 23, 2013 at 5:20 pm
I've seen this, but that still doesn't mean pathologists regularly call out growth phase. It isn't universal….yet! And if it is truly a telling piece of evidence, it will likely be incorporated into future staging. That's how all the staging factors came about. Additional research showed they were significant and telling in prognosis so they were adopted as part of the staging criteria.
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- January 23, 2013 at 5:20 pm
I've seen this, but that still doesn't mean pathologists regularly call out growth phase. It isn't universal….yet! And if it is truly a telling piece of evidence, it will likely be incorporated into future staging. That's how all the staging factors came about. Additional research showed they were significant and telling in prognosis so they were adopted as part of the staging criteria.
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- January 23, 2013 at 3:39 pm
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- January 23, 2013 at 3:05 pm
Invasive radial growth is stage IA, not stage 0. That's not the same thing. Any depth means it isn't melanoma in situ. Yes, radial growth phase has a better prognosis than vertical growth phase, but it is not confined to the epidermis. That designation is "new" in pathology terms and growth phase is not called out in all lesions, yet. I think a few years will have to pass before the real stats on that particular attribute are accepted.
It is thought that melanoma in situ might be over diagnosed — pathologists erring on the side of "melanoma" versus "atypical" to cover themselves. The incidence of melanoma in situ has risen dramatically, but the stats for all other stages has not changed comparably. As this poster's path report showed, this is "early" and "evolving" which may leave this lesion open to interpretation. A different pathologist might classify this differently. One designation they use for Lentigo Maligna / Lentigo Maligna Melanoma is that it is not called Lentigo Maligna Melanoma until it becomes invasive. It is Lentigo Maligna when in situ. Obviously, that is only one subtype of melanoma, but it is distinguished differently and not called "melanoma" until it becomes invasive.
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- January 23, 2013 at 3:19 pm
It's fairly normal for people who know something about skin cancer to freak out when they see the word "melanoma" in their pathology report. You are wise to read the report carefully and critically. I am not a physician, but if I was to translate your path report into plain English, I would say, "This is a funny-looking mole with just the tiniest beginning of melanoma. The cell architecture was interesting for the pathologist to look at, but as far as the patient is concerned, the whole thing has been removed. A wide local incision is recommended just to make certain sure that there is no recurrance."
If you are still anxious, I suggest you call the pathologist who signed the report and ask your specific questions. The pathologists I have talked to are usually thrilled that a patient even knows they exist and appreciates how important the pathologist is to the patient's healthcare team.
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- January 23, 2013 at 3:19 pm
It's fairly normal for people who know something about skin cancer to freak out when they see the word "melanoma" in their pathology report. You are wise to read the report carefully and critically. I am not a physician, but if I was to translate your path report into plain English, I would say, "This is a funny-looking mole with just the tiniest beginning of melanoma. The cell architecture was interesting for the pathologist to look at, but as far as the patient is concerned, the whole thing has been removed. A wide local incision is recommended just to make certain sure that there is no recurrance."
If you are still anxious, I suggest you call the pathologist who signed the report and ask your specific questions. The pathologists I have talked to are usually thrilled that a patient even knows they exist and appreciates how important the pathologist is to the patient's healthcare team.
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- January 23, 2013 at 3:19 pm
It's fairly normal for people who know something about skin cancer to freak out when they see the word "melanoma" in their pathology report. You are wise to read the report carefully and critically. I am not a physician, but if I was to translate your path report into plain English, I would say, "This is a funny-looking mole with just the tiniest beginning of melanoma. The cell architecture was interesting for the pathologist to look at, but as far as the patient is concerned, the whole thing has been removed. A wide local incision is recommended just to make certain sure that there is no recurrance."
If you are still anxious, I suggest you call the pathologist who signed the report and ask your specific questions. The pathologists I have talked to are usually thrilled that a patient even knows they exist and appreciates how important the pathologist is to the patient's healthcare team.
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