Atipycal Spitz Dermatopathology Report

Hello everyone!
I have been reading the posts on this forum for a few weeks after I got a call back from my dermatologist suspecting that I may have a melanoma.
I am 31, female and have lots of moles pretty much all over my entire body. I am extremely fair skinned, have really light blue/gray eyes, ash blonde hair and always burn in the sun.. Sun protection was never a huge deal when I was growing up-even after my grandmother had almost half her face cut off with Basal Cell Cancer…They all tan so easily and never got burnt so my parents just didn’t understand why I always burned, nor did they really do anything to prevent it. I’ve probably had sun poisoning about 8 times in my life. Last year I ended up with 3rd degree burns from the sun all over my top half of my body and one leg(i used sunscreen in the spray form 3 times over a 3 hour period). On that leg, on my thigh, about 3 years prior a small pink freckle appeared. Well over the last 10 months it morphed into the size of a pink pencil eraser from a #2 pencil that had been used about half the way down. I used tanning beds off and on from about 16-25. I finally got insurance by becoming full time as my job and made a slew of appointments to get caught up and seen by several types of doctors. I went to the ER with my sunburn last year and the ER physician told me I needed to follow up with a Dermatologist ASAP, and that I would likely end up with skin cancer. Well it wasn’t really an option and I didn’t pay much mind to it, as I’ve said, I’ve had multiple severe burns my entire life, blisters and all!
10/18 was the biopsy
10/21 I got the call from the derm about suspecting melanoma and a FISH analysis was requested. They called it an Atypical Spitzoid
11/18 I had my follow up about the results from my FISH analysis. I will provide the report below. My derm said I should have a WLE, but was unsure because of the “unknown gray area” that is atypical spitzoid, whether a SLNB should be performed and left it up to me. I guess I would just like some outside opinions on if I should go through with the SLNB or not. She said she would give me a referral to Dr. Delman at the Winship Emory if I wanted to see about having it done. She said he specializes in the unknown and weird types. She also said she could not provide me with any statistics on how people with these fare later down the road with or without the SLNB due to lack of studies and evidence as these aren’t very common, rare even. She said she really didn’t have a definitive answer on if it was, or was not or could be at a later time, a melanoma.
This is the Dermatopathology Report on my FISH analysis.

RESULTS:
A. Skin, Right Anterior Distal Thigh, Biopsy by Shave Method.
ATYPICAL COMPOUND MELANOCYTIC NEOPLASM WITH SPINDLE AND EPITHELIOD CELLS
(see description and comment)
THE DEEP AND ONE LATERAL SECTION EDGES ARE INVOLVED

COMMENT:
Overall the histologic changers are those of a compound melanocytic neoplasm with spindle and epithelioid cells and some atypical features, including the clinical situation. The histologic finding, immunostaining pattern, and FISH results favor an atypical compound spitzoid neoplasm but the differential would also include a spitzoid melanoma with a Breslow depth of 0.8 mm, at least. Therefore a conservative excision is recommended to ensure complete removal and allow further diagnostic evaluation.

Due to the complex nature of this neoplasm and consideration for a possible spitzoid melanoma, this specimen was sent to NeoGenomics for FISH studies. The reported finding within normal limits for RREB1, cMYC, CDKN2A/p16, and CCND1. The full report is on file and available for review upon request.

Stain Results
Ki-67: Positive
Melan-A: Positive
P16: Positive
SOX-10: Positive

SPECIMEN DESCRIPTION:
Gross Description
A. The specimen is received in 10% buffered formalin, labeled with anatomic site, patient’s DOB, patient’s name, and unit number
It is given an accession number. It consists of a portion of tan skin measuring 1.0 x .6 x .2 cm. It is sectioned in 3 pieces. The specimen is submitted in toto in 1 cassette: a-1 (3)

Microscopic Description
A. Sections show skin with hyperkeratosis, and acanthosis of the epidermis. In the epidermis and dermis there is a proliferation of epithelioid and spindle cells distributed predominately as dyscohesive nests at the dermal-epidermal junction and in the papillary and reticular dermis. The melanocyter are large, with abundant amphophilic cytoplasm and prominent nucleoli. The nest and cells mature with increasing dermal depth although some nuclei are hyperchromatic and pleomorphic. Occasional eosinophilic globoid (Kamino) bodies are noted in the epidermis and superficial dermis. The neoplasm appears well circumscribed but is asymmetrical overall. Immunostains for melan-A and SOX10 confirm the distribution of melanocytes in the lesion with p16 displays preserved staining of the dermal melanocytes. Ki-67 reveals a low proliferative index.

Clinical Information
Impression History
a. Rule-out Dysplastic Nevus Vs. Dermatofibroma vs. Basal cell carcinoma, Morphology: Erythematous scaling verrucous papule, Biopsy by Shave Method.

End.

So! Anyways, since I have seen all sorts of stuff on this forum, with tons of experience… I just thought I would reach out and see if I could gather an opinion of if I should have the SLNB when I have the WLE. She said that if I chose to not have the SLNB that it would be an in office procedure and I would not be put to sleep- but that she would give me some nerve meds while I was there and send me home with some pain meds for a few days afterwards. If I do go through with the SLNB, I would be put to sleep and they would do both procedures at that time.

Thanks for being so patient, and taking the time to get through all the details. I appreciate you!
-Brittney