Very Weird and Large Amelanotic Melanoma Update

Here is the path report from the first exision on 8/16/18

FINAL DIAGNOSIS:

Skin, left postauricular scalp, excision: Inflammation, fibrosis, and
residual melanoma, widely excised.

CLINICAL INFORMATION:
Specimen(s): Left postauricular scalp, melanoma, additional donut,
stitch at 12 o'clock. ICD code(s): C43.9.

GROSS DESCRIPTION:
The specimen is received in a formalin-filled container having the
patient's printed identification data including the patient's name
"Patient Name" The specimen consists of a non-elliptical, somewhat
circular donut-shaped biopsy of skin marked with a suture with
orientation as indicated on the requisition site/other. This is then
designated the "12 o'clock position". The outside diameter of the donut
biopsy measures 10.7 x 10 cm to a depth of 0.5 cm. The inside diameter
of the donut biopsy measures 7 x 6.5 cm to a depth of 0.5 cm. The
outside margin is inked green; the inside margin is inked black. The
surface of the skin is variably beige to light tan with dark hair
extending from the 4 o'clock position until the 11 o'clock position. The
measurement of skin wideness at the 12 o'clock position is 1.9 cm, 1
o'clock position is 1.8 cm, 2 o'clock position is 1.9 cm, 3 o'clock
position is 2 cm, 4 o'clock position is 1.8 cm, 5 o'clock position is 2
cm, 6 o'clock position is 1.7 cm, 7 o'clock position is 1.6 cm, 8
o'clock position is 1.5 cm, 9 o' clock is 1.7 cm, 10 o'clock position is
0.8 cm, and the 11 o'clock position is 2 cm. The ellipse is serially
sectioned in a clockwise direction into 74 pieces and entirely embedded
in 25 cassettes with seven sections from the 12 o'clock to 1 o'clock
position embedded in cassettes A1-A3, five sections from the 1 o'clock
to 2 o'clock position embedded in cassettes A4-A5, five sections from
the 2 o'clock to 3 o'clock position embedded in cassettes A6-A7, six
sections from the 3 o'clock to 4 o'clock position embedded in cassettes
A8-A9, six sections from the 4 o'clock to 5 o'clock position embedded in
cassettes A10-A11, five sections from the 5 o'clock to 6 o'clock
position embedded in cassettes A12-A13, six sections from the 6 o'clock
to 7 o'clock position embedded in cassettes A14-A15, six sections from
position 7 o'clock to 8 o'clock embedded in cassette A16-A17, eight
sections from positions 8 o'clock to 9 o'clock embedded in cassettes
A18-A19, eight sections from positions 9 o'clock to 10 o'clock embedded
in cassettes A20-A21, seven sections from positions 10 o'clock to 11
o'clock are embedded in cassettes A22-A23, and five sections from
position 11 o'clock to 12 o'clock are embedded in cassettes A24-A25.
(re/mm)

MICROSCOPIC DESCRIPTION:
There is inflammation and fibrosis characteristic of prior procedure
site. There is residual atypical nested melanocytes at the
dermoepidermal junction and in the superficial dermis, characteristic of
residual melanoma. The specimen was labeled with antibodies to Melan-A
(see below) which better delineated the neoplasm. Margins are widely
free of the neoplasm in the examined sections.

IMMUNOHISTOCHEMISTRY STUDY:
Deparaffinized sections of formalin-fixed tissue and the appropriate
controls are incubated with the antibodies/antibody listed below.
Localization is via: biotin free multimer immunoperoxidase method.
Results are outlined in the table below:
Block A1
Cells of interest

Antibody  Result    Comment
Melan A RED    Positive

Block A2
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A3
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A4
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A5
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A6
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A7
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A8
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A9
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A10
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A11
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A12
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A13
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A14
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A15
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A16
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A17
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A18
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A19
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A20
Cells of interest

AntibodyResultComment
Melan A RED    Negative

Block A21
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A22
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A23
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A24
Cells of interest

AntibodyResultComment
Melan A RED    Positive

Block A25
Cells of interest

AntibodyResultComment
Melan A RED    Positive