Path Report help Please!
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Path Report help Please!

› Forums › Cutaneous Melanoma Community › Path Report help Please!

  • Post
    • June 15, 2012 at 11:41 am
    Rdmstm
    Participant
    Ten days ago I went to my dermatologist for my yearly body scan. She removed a new freckle/mole, but didn’t think it would be a problem. To my absolute shock, my DR informed me that I have melanoma. Below is the Path report from this original excision. I’m meeting with surgeons next week to discuss surgical options for a second excision,  and am extremely terrified they may tell me something very bad. I’ve been consuming myself with the internet, and other Path reports sound more detailed. Are these path reports of the second excisions?? On the below report I’m concerned that there is no depth measurement and the Microscopic description sounds frightening. Can anyone give me insight of the below terminology???  

    Diagnosis: melanoma in-situ, early lesion
    note: the lesion extends to lateral margins)

    Clinical Data History:
    shave w/ margins, 0.2 x 0.3 new 2 tone macule, R/O A typical nevus

    Gross Description:
    a shave biopsy of skin measuring 9 x 5 x 1 mm. 

    Microscopic Description
    Melanocytes, some of which have hyperchromatic nuclei, are arranged as solitary units and in nests with the epidermis.  There is poor circumscription and in foci melanocytes arranged as solitary units predominate over nests.

    Still trying to awaken from this nightmare….

Viewing 2 reply threads
  • Replies
      • June 15, 2012 at 12:24 pm
      Janner
      Participant

      The important biopsy reports are the first ones.  This is where the lesion is mostly removed.

      It sounds like this lesion is an EARLY evolving melanoma in situ.  As far as melanoma is concerned, this is the best diagnosis you can have.  It basically has about a 100% cure rate.  Nothing is ever absolute, but it's about as good as you can get with melanoma.  Melanoma in situ has no depth by definition.  It is totally confined to the epidermis.  Depth is measured from the epidermal/dermal junction downward.  The epidermis doesn't have any blood or lymph vessels so really lacks any vehicle to spread.  This is why it has such a good prognosis.  Some path reports are more detailed than others but not always.  As for the microscopic description, it isn't particularly helpful to analyze it word by word.  This is just the justification of the pathologist for making the final diagnosis.  He's describing characteristics of the lesion that justify a melanoma in situ diagnosis. 

      You will need to have the WLE (wide local excision).  This is where they will remove any remaining portions of the lesion as well as 5mm of extra margins around the entire lesion.  Then you just continue to watch your skin for other changes.  It's not common to have more than one melanoma, but it is possible.  So watching your other moles for change is important, too.  Watch your scar area for any pigment regrowth as well.  Practice sun safety.  Live life.  While this might be a shock, the prognosis is good!  Live life! 

      Best wishes,

      Janner

      • June 15, 2012 at 12:24 pm
      Janner
      Participant

      The important biopsy reports are the first ones.  This is where the lesion is mostly removed.

      It sounds like this lesion is an EARLY evolving melanoma in situ.  As far as melanoma is concerned, this is the best diagnosis you can have.  It basically has about a 100% cure rate.  Nothing is ever absolute, but it's about as good as you can get with melanoma.  Melanoma in situ has no depth by definition.  It is totally confined to the epidermis.  Depth is measured from the epidermal/dermal junction downward.  The epidermis doesn't have any blood or lymph vessels so really lacks any vehicle to spread.  This is why it has such a good prognosis.  Some path reports are more detailed than others but not always.  As for the microscopic description, it isn't particularly helpful to analyze it word by word.  This is just the justification of the pathologist for making the final diagnosis.  He's describing characteristics of the lesion that justify a melanoma in situ diagnosis. 

      You will need to have the WLE (wide local excision).  This is where they will remove any remaining portions of the lesion as well as 5mm of extra margins around the entire lesion.  Then you just continue to watch your skin for other changes.  It's not common to have more than one melanoma, but it is possible.  So watching your other moles for change is important, too.  Watch your scar area for any pigment regrowth as well.  Practice sun safety.  Live life.  While this might be a shock, the prognosis is good!  Live life! 

      Best wishes,

      Janner

        • June 15, 2012 at 1:54 pm
        Rdmstm
        Participant
        Thank you Janner!! The left side of my neck hurts and appears to be swollen. Will my surgeon be able to perform the lymph node test, or is this a different procedure.
        Scared silly!!
        • June 15, 2012 at 1:54 pm
        Rdmstm
        Participant
        Thank you Janner!! The left side of my neck hurts and appears to be swollen. Will my surgeon be able to perform the lymph node test, or is this a different procedure.
        Scared silly!!
        • June 15, 2012 at 2:59 pm
        Janner
        Participant

        Where was your melanoma located?  A sentinel lymph node biopsy (SNB) is never done for melanoma in situ.  Since in situ doesn't have access to lymph vessels, there really is no reason to check the lymph nodes.  The SNB is typically only done for lesions > 1mm.  Neck nodes swell all the time for a variety of reasons and are usually related to some type of illness or trauma.

        Don't be scared, you caught this extremely early and your likelihood of dying in a car accident is much higher than dying from melanoma.  Being newly diagnosed is difficult, but you have an excellent prognosis.  Don't imagine the worst because in all likelihood, this is the only time you will ever deal with melanoma.

        • June 15, 2012 at 2:59 pm
        Janner
        Participant

        Where was your melanoma located?  A sentinel lymph node biopsy (SNB) is never done for melanoma in situ.  Since in situ doesn't have access to lymph vessels, there really is no reason to check the lymph nodes.  The SNB is typically only done for lesions > 1mm.  Neck nodes swell all the time for a variety of reasons and are usually related to some type of illness or trauma.

        Don't be scared, you caught this extremely early and your likelihood of dying in a car accident is much higher than dying from melanoma.  Being newly diagnosed is difficult, but you have an excellent prognosis.  Don't imagine the worst because in all likelihood, this is the only time you will ever deal with melanoma.

        • June 16, 2012 at 1:59 am
        Rdmstm
        Participant
        My melanoma was on the left mid-side of my back. I find your word very comforting right now. As you can tell I’m having a difficult time accepting that this is really happening to me! …. Thank you for your kind words!!!
        • June 16, 2012 at 1:59 am
        Rdmstm
        Participant
        My melanoma was on the left mid-side of my back. I find your word very comforting right now. As you can tell I’m having a difficult time accepting that this is really happening to me! …. Thank you for your kind words!!!
        • June 16, 2012 at 1:59 am
        Rdmstm
        Participant
        My melanoma was on the left mid-side of my back. I find your word very comforting right now. As you can tell I’m having a difficult time accepting that this is really happening to me! …. Thank you for your kind words!!!
        • June 15, 2012 at 2:59 pm
        Janner
        Participant

        Where was your melanoma located?  A sentinel lymph node biopsy (SNB) is never done for melanoma in situ.  Since in situ doesn't have access to lymph vessels, there really is no reason to check the lymph nodes.  The SNB is typically only done for lesions > 1mm.  Neck nodes swell all the time for a variety of reasons and are usually related to some type of illness or trauma.

        Don't be scared, you caught this extremely early and your likelihood of dying in a car accident is much higher than dying from melanoma.  Being newly diagnosed is difficult, but you have an excellent prognosis.  Don't imagine the worst because in all likelihood, this is the only time you will ever deal with melanoma.

        • June 15, 2012 at 1:54 pm
        Rdmstm
        Participant
        Thank you Janner!! The left side of my neck hurts and appears to be swollen. Will my surgeon be able to perform the lymph node test, or is this a different procedure.
        Scared silly!!
        • March 9, 2018 at 12:49 am
        teddyh101
        Participant
        Hi Janner, would you be willing to answer a few questions for me via email? Thank you
      • June 15, 2012 at 12:24 pm
      Janner
      Participant

      The important biopsy reports are the first ones.  This is where the lesion is mostly removed.

      It sounds like this lesion is an EARLY evolving melanoma in situ.  As far as melanoma is concerned, this is the best diagnosis you can have.  It basically has about a 100% cure rate.  Nothing is ever absolute, but it's about as good as you can get with melanoma.  Melanoma in situ has no depth by definition.  It is totally confined to the epidermis.  Depth is measured from the epidermal/dermal junction downward.  The epidermis doesn't have any blood or lymph vessels so really lacks any vehicle to spread.  This is why it has such a good prognosis.  Some path reports are more detailed than others but not always.  As for the microscopic description, it isn't particularly helpful to analyze it word by word.  This is just the justification of the pathologist for making the final diagnosis.  He's describing characteristics of the lesion that justify a melanoma in situ diagnosis. 

      You will need to have the WLE (wide local excision).  This is where they will remove any remaining portions of the lesion as well as 5mm of extra margins around the entire lesion.  Then you just continue to watch your skin for other changes.  It's not common to have more than one melanoma, but it is possible.  So watching your other moles for change is important, too.  Watch your scar area for any pigment regrowth as well.  Practice sun safety.  Live life.  While this might be a shock, the prognosis is good!  Live life! 

      Best wishes,

      Janner

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