is there a connection?
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is there a connection?

› Forums › General Melanoma Community › is there a connection?

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    • February 1, 2018 at 8:09 pm
    sjsparks
    Participant

    Hi newbie here!
    I am 36, I was diagnosed in October 2016 with Stage 2 aggressive triple positive breast cancer.  I had 100% response to chemo. I did not need radiation.  I had a bilateral mastectomy and DIEP flap recon. Fast forward to 1/31/2018 I got a call from my dermatologist that my scratch biopsy came back High-Density Intraepidermal melanocytic proliferation with severe atypia.  With my past and cancer, I am extremely anxious with this news.  I'd like to chat and get advice and opinions on what to expect.

    Thanks so much, Shannon.
     

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      • February 1, 2018 at 8:26 pm
      Janner
      Participant

      A severely atypical lesion is not considered melanoma, but COULD have become melanoma.  (Most atypical lesions don't but severely atypical lesions have a higher risk).  The treatment is a WLE – wide local excision – with 5mm margins.  I'm not sure there would be any relationship to your breast cancer directly.  There have been some studies that might show a genetic link between BC and melanoma but again, this lesion isn't technially melanoma.  Chemo also adds in an unknown in how it affects the rest of the body. 

      But the bottom line is – you need to have surgery to remove the lesion.  Followup is watching your skin for any changing lesions, regular derm visits, practice sun safety and watching the scar area for any pigment regrowth. 

        • February 1, 2018 at 8:29 pm
        sjsparks
        Participant

        Thank you for responding so quick. I am scheduled Feb 8th for Mohs surgery.  The pathology report says I will recieve a full pathologic evaluation. I am guessing this will happen after the removal?

        • February 1, 2018 at 8:44 pm
        Janner
        Participant

        Where is this located?  Mohs isn't the standard treatment for this type of lesion removal but it sometimes done.  The surgeon removes tissue, it is analyzed immediately via frozen setion pathology and more tissue is taken until margins are achieved.  Mohs is a tissue saving technique most often used for other types of skin cancer.  In general, most melanoma type lesions are removed with a WLE then the tissue is analyzed after slicing and processing in paraffin with staining.  Mohs uses a frozen section pathology which doesn't show melanocytes as well as when they are stained and processed.  That doesn't mean this isn't appropriate for your lesion, I'm just explaining the general rationale. 

        Were clean margins achieved on your biopsy?  Either way, there should be an additional pathology report.  If you had clean margins on the biopsy, nothing is likely to change after margins are taken. 

        • February 1, 2018 at 8:58 pm
        sjsparks
        Participant

        The initial biopsy was just a scrap for what I know, just the top was taken off.  It is on my right shoulder blade area.  Here is what the entire pathology report says;

        A. Right Upper Back, Biopsy by Shave Method

        High-Density Intraepidermal Melanocytic Proliferation with severe atypia; re-excision recommended

        Comment: As the Atypical Melanocytic proliferation extends to the margins of the specimen, complete excision of th esite is recommended for treatment and full pathologic evaluation

         

        specimen Description

        A. The specimen is received in 10% buffered formalin. It is given an accession number. It consists of a portion of fragment of tissue measuring 0.5 x 0.4x 0.1cm. It is sectioned in 2 pieces and submitted in 1 cassette: A-1 (2).

         

        Microscopic Description 

        A. There is an asymmetrical proliferation of atypical melanocytes arranged as irregular nests and single cells along the dermoepidermal junction as well as above it. In some areas, there is a more  uniform arrangement of junctional nests and intradermal melanocytes in the pattern of a pre-existing dysplastic nevus. A well-controlled MART-1 immunoreaction highlights the melanocytic proliferation. 

        Clinical Information

        Impression History

        A. Dysplastic Nevus, Morphology; irregular brown macule, Biopsy by Shave Method. 

        • February 1, 2018 at 9:49 pm
        Janner
        Participant

        Ok.  The lesion has involved margins all around.  Shave biopsies aren't always the best because, like here, they can bisect a lesion.  If it were melanoma, this could compromise staging.  So this report was done via the method I stated above – paraffin and staining.  You will get a similar report after the Mohs analyzing the rest of the tissue.  Most of the time, the final diagnosis doesn't change. 

        • February 1, 2018 at 10:00 pm
        sjsparks
        Participant

        Thank you for all your imput!

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