Understanding the Pathology Report

Hello, I am newly diagnosed with what is being called Spitzoid type Melanoma. I am currently awaiting Wide Excision surgery and Sentinal Node Biopsy. I am curious if someone can help put the Pathology report into Lehman's terms. I understand the staging, depth and clarks, but beyond that, can't wrap my head around the seriousness, if any. Can someone help? I had two biopsies performed, the first is listed first.

Malignant melanoma, spitzoid type.
Breslow measurement: At least 1.1 millimeters.
Clark's level: IV.
Surface ulceration: Absent.
Precursor lesion: Not identified.
Regression: Not identified.
Lymphocytic response: Nonbrisk.
Mitotic index: 1/mm 2.
Lymphovascular channel involvement: Not identified.
Neurotropism: Not identified.
Satellite lesions: Not identified.
Margins: Tumor extends to the deep and lateral margins.
Tumor staging: At least pT2aNxMx.
See comment.

COMMENTS:

This case was sent for consultation to Dr. Pedram Gerami at North Western Medical Group Department of Dermatology. His additional comments are as follows:

''The sections show a markedly atypical spitzoid melanocytic neoplasm. There is high grade nuclear atypia, notable pleomorphism and lack of maturation. FISH studies showed chromosomal copy number gains in 6p25 and 11q13 in greater than 50% of enumerated cells consistent with a diagnosis of Spitzoid melanoma. Homozygous deletions at 9p21 were not identified.
FISH evaluation using probes for Cyclin D1, RREB1, MYB and CEP6 were performed. These probes are approved as analytic specific reagents. In our laboratory, this probe set performed with a sensitivity of 86.7% and specificity of 95.4% in distinguishing benign nevi from melanoma. Thirty cells were enumerated. Less than 55% of cells showed relative gain of RREB1 but greater than 30% of cells show absolute gain of RREB1. The average MYB per CEP6 loss is less than 40%. Greater than 38% of cells had gain in Cyclin D1. The average nuclear signals for CEP6 was less than 2.5. We also performed FISH targeting 9p21 and CEP9 and there is no evidence of homozygous deletions.''

END OF CONSULTANT'S NOTE

CLINICAL INFORMATION

CLINICAL HISTORY:
Preoperative Diagnosis: A. ICD: D48.9 NUB, Nevus, R/O atypia. B. ICD: D48.9 NUB, Nevus, R/O atypia.
Postoperative Diagnosis:
Symptoms/Radiologic Findings:
Procedure:

MICROSCOPIC EXAMINATION:

A. There are uniform clusters of benign appearing nevus cells in the dermis. A junctional component is not appreciated.

B. Sections show a spitzoid melanocytic proliferation confined to the dermis. The overlying epidermis shows acanthosis. The melanocytes have an epithelioid morphology with scattered pleomorphic cells. To better evaluate this lesion, the following immunohistochemical stains are performed and compared to appropriate stained controls: Melan-A/Ki-67 dual stain, HMB-45, P16. The Melan-A/Ki-67 dual stain demonstrates an intradermal proliferation of epithelioid cells with a slight increase in the proliferation index. The HMB-45 demonstrates variable staining. The P16 demonstrates loss of p16 in areas.

Malignant melanoma, spitzoid type.
Breslow measurement: At least 2.5 millimeters, focally transected at the base.
Clark's level: At least IV, focally transected at the base.
Surface ulceration: Absent.
Precursor lesion: Not identified.
Regression: Not identified.
Lymphocytic response: Non-brisk.
Mitotic index: Less than one per square millimeter.
Lymphovascular channel involvement: Not identified.
Neurotropism: Not identified.
Satellite lesions: Not identified.
Margins: Tumor extends to the deep margin.
Tumor staging: At least pT3aNX.

CLINICAL INFORMATION

CLINICAL HISTORY:

Preoperative Diagnosis: ICD Code: D48.9 NUB. Biopsy proven spitzoid melanoma reshave for micro staging.

MICROSCOPIC EXAMINATION:

Sections show a markedly atypical spitzoid melanocytic neoplasm confined to the dermis. The lesion shows variable cellularity with frequent pleomorphic cells and multinucleated cells. The melanocytes fail to mature with decent into the dermis. The lesion is transected at the deep margin through the deep reticular dermis.