eb_scared

Hi, this is the biopsy report in case anyone has any insights about what it means. I know you can't diagnose me and there will be an element of uncertainty at least until the final biopsy is done. I would appreciate especially if anyone has insights about ki-67 as this sounds awfully concerning, as does the atypical nest formation because I remember reading that this was a bad sign. But I don't really understand it. I'm concerned the ki-67 finding could be a really bad sign that melanoma is in the region below the original biopsy.

I wish i'd demanded a deeper biopsy on this one. The hassle and extremely minor disfigurement of a few stitches would have been well worth it. Lesson learned!! 🙁

Right anterior thigh (RD): Atypical compound melanocytic proliferation with intraepidermal melanocytic ascent (see comments) (D48.5). Comment: There is a limited portion of this lesion present for evaluation which shows cytological atypia, elevated proliferative index at the junction of Ki67, upward melanocytic scatter, and irregular nest formation. Although these findings potentially could be seen in a traumatized atypical nevus, a more atypical lesion cannot be excluded on this partial biopsy. A re-excision is suggested for removal and to allow for complete evaluation.

I wanted to give an update in case it will help someone else. I had the spot re-biopsied, and it came back totally normal, not even atypical. In retrospect, the initial biopsy process was a train wreck for several reasons.

(1) The mole had not changed at all before becoming irritated. There was an obvious source of irritation (wearing polyester leggings on a camping trip). It was a "just in case" biopsy, which ended up causing far more grief than I ever could have imagined.

(2) The PA who took the biopsy took an extremely thin slice. She even remarked that it would be "VERY THIN." I vaguely remembered warnings that this can lead to uncertain prognoses. But I thought, hey, it's probably nothing, this is "just in case," it will probably come back totally normal, and I will barely have a scar. Thanks to that decision, I now have a somewhat big scar. The pathologists barely had anything to work with, nor were they given a clinical context for the tiny initial sample.

(3) The mole was still irritated when biopsied. Melanoma diagnosis is not always black and white, as many of the features are simply features of cell division and spreading. Those same exact processes happen to some degree when a mole has been traumatized or even just sunburned!

(4) The clinic I went to handled the situation with no regard to my emotional experience. I got a phone call from the grim-sounding PA saying to call back. I knew something was off because they had left me a message before about a result coming back mild atypia. I got the message while overseas and spent hours agonizing in my hotel, waiting for the office to open so I could talk to someone. I think the "grim" feeling I sensed was actually the PA's frustration at realizing she had made a mistake by taking such a thin biopsy. The person I got hold of on the phone was another PA, unaware of the circumstances, who simply read the biopsy report to me and said "I'm sorry, honey, I can't confirm it's not cancer."

(5) Later, when I tried to get the mole sent to another pathology lab for a second opinion, the physician's office acted like I was asking them for something way over the top. They had no idea what to do. They were going to send the mole (preserved in slices on microscope slides) to my house and have me fill out all the paperwork and send it myself! Fortunately I found another dermatologist who was very helpful in discussing the way forward.

I just wanted to put it out there. Obviously don't hesitate to get a biopsy or re-excision of a suspicious mole, but there are some caveats to be aware of if you do get an inconclusive result.

Thanks a lot Janner!! I did find a bit of research titled "Sunburn, Trauma, and Timing of Biopsies of Melanocytic Nevi" (Pharis & Zitelli 2001) describing how an ok mole can look horrible in the biopsy if it was recently sunburned or traumatized. So I'm hoping that's what happened, since it was definitely traumatized. Anyway, thanks for your response.