MIS or Stage 1a…Dermpathologist cant decide????
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MIS or Stage 1a…Dermpathologist cant decide????

› Forums › General Melanoma Community › MIS or Stage 1a…Dermpathologist cant decide????

  • Post
    • April 28, 2016 at 4:24 pm
    m355
    Participant

    This one is a doozy!!! As much as I would prefer a MIS, it appears to me a stage 1A since there is a breslow depth of .32.  They are treating as a stage 1 which I am okay with being aggressive.  I am having sent to my other dermapathologist back home for his review too.  Of the 4 derm path. 1 said MIS, 1 undecided, 2 for stage 1.  The mole appeared new or was a super light freckle (cant really tell on my professional pictures).  The 0 mitotic rate is throwing them off too…

    Here is lab report:

    A) Skin, right upper back, punch biopsy: Severely
    atypical compound melanocytic proliferation, see
    Comment.

    COMMENT:
    This is a worrisome lesion, with epidermal atypia
    (pagetoid extension, confluent growth) consistent with
    melanoma in situ and a dermal component that also
    demonstrates atypia with areas of morphologically
    similar cells to the epidermal component, but also some
     reassuring features (dispersion with increasing dermal
     depth, absence of mitoses). These findings engender a
    differential diagnosis that could reasonably include
    melanoma in situ evolving within a dysplastic nevus or
    a superfically invasive melanoma. Given this
    differential, it would be reasonable to treat this
    lesion as if it represents a malignant melanoma with
    the following prognostic factors: Breslow depth 0.32mm,
     Clark's level II, 0 mitoses/mm2, no ulceration.
     

    MICROSCOPIC DESCRIPTION:
    A) Sections show a punch biopsy with a compound
    melanocytic proliferation. The junctional component
    shows crowding, with fusion between adjacent rete and
    horizontal nests. Areas of upward extension of single
    melanocytes and nests are seen, and highlighted by
    Melan-A. Intraepidermal melanocytes show cytologic
    atypia, with nuclear enlargement and abundant
    cytoplasm. A patchy lymphohistiocytic inflammatory
    infiltrate is present. The lesion is free of the punch
    biopsy margin. Additional step sections are examined.
     

     

    Melan A test is positive
     

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  • Replies
      • April 28, 2016 at 5:21 pm
      Janner
      Participant

      Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

      • April 28, 2016 at 5:21 pm
      Janner
      Participant

      Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

      • April 28, 2016 at 5:21 pm
      Janner
      Participant

      Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

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