› Forums › Cutaneous Melanoma Community › Can somebody please help me with this pathology report?
- This topic has 9 replies, 2 voices, and was last updated 10 years, 11 months ago by
Janner.
- Post
-
- May 29, 2013 at 4:16 am
My husband got diagnosed as lentigo maligna of the left ear auricle from a punch biopsy. (Mar, 2013)
He had a wide excision surgery at another hospital (Apr, 2013) and here is the exact copy of the post-surgery pathology report.
————————————————————————————————————————————
Name of the specimen: Skin
Test items: Gross Photo (2ea)
My husband got diagnosed as lentigo maligna of the left ear auricle from a punch biopsy. (Mar, 2013)
He had a wide excision surgery at another hospital (Apr, 2013) and here is the exact copy of the post-surgery pathology report.
————————————————————————————————————————————
Name of the specimen: Skin
Test items: Gross Photo (2ea)
Immun[ki-67(M1B1)]
Immun[Melanoma Ag(HMB45)]
Immun[S-100]
Immun[Melan-A]
[Resected Specimen]no more than 6 Histopath Exam
<GROSS DESCRIPTION>
The specimen labeled as “left ear choncha area” consists of a portion of choncha, measuring 3.0X2.8X1.0cm. The skin shows a dark brownish pigmented lesion, measuring 0.7X0.4cm. It is 1.0cm, 1.0cm, 1.3cm, and 1.1cm apart from the superior, inferior, anterior and posterior resection margins. Multisected and representative sections are embedded in block A1 to A8.
Color key: yellow: anterior, red: superior, blue:inferior, green: posterior, black: deep
FINAL DIAGNOSIS :
Skin, ear, choncha, left, wide excision:
- Primary tumor diagnosis: Lentigo malignant melanoma
- Level of invasion(Clark level):
- Confined to the epidermis,
With all tumor cells above the basement membrane
Note) Use only with thickness 1.0mm or less than 1.0mm(otherwise omit)
3. Epidermal ulceration: Absent
Note) Difined as the absence of an intact epidermis overlying a major portion of the primary melanoma
4. Mitotic rate: 0/mm2
5. Resection margin: Margins are free of tumor (superior: 1.0cm, inferior: 1.0cm, anterior: 1.3cm, posterior: 1.1cm, deep: 0.4cm)
6. Additional features:
Lymphovascular invasion: Absent
Neurotropism: Absent
Intraepidermal pattern(lentiginous)
Cell type(epithelioid)
Associate nevus(not identified)
Lymphocytic infiltrate(non-brisk)
Desmoplasia: Absent
Tumor regression: Absent
Note) 1. The result of immunohistochemistry;
HMB45: Positive
Melan-A: Positive
S-100: Positive
Ki-67 labelling index: <5%
2. Mapping is done.
3. Intradepartment consultation is done.
——————————————————————————————————————————
I left what looks like spelling errors to me like “choncha” and “difined” the way they are, as I am not exactly an expert on these things.
My questions are:
- What is “lentigo malignant melanoma”? I have seen information about “lentigo maligna” and” lentigo maligna melanoma” but I have never heard of “lentigo malignant melanoma”. Is it a spelling mistake? Or is it something else?
- Our dermatologist had said “lentigo maligna” is different from “lentigo maligna melanoma”, in that the former is a precursor to cancer, for which wide excision is required to prevent it from becoming a cancer. He said that unlike the latter, PET scan is not necessary for “lentigo maligna”.
But the surgeon he referred us to said “lentigo maligna” is one of the four major types of melanoma and prescribed PET-CT and CT scan, saying the parotid gland possibly has to be removed. This confusion and the conflicting information was the major reason why we changed hospitals.
Anyway, our new surgeon(a very specialized ear-reconstruction surgeon) said, after the surgery was done and the final pathology report was written, that my husband’s final diagnosis “lentigo malignant melanoma” is correct, but it is still the same diagnosis as the initial biopsy result. This doesn’t make any sense to us. Who/what should we trust and what should we do?
3. What do the items in the parenthesis mean? And the result of the immunohistochemistry?
Intraepidermal pattern(lentiginous)
Cell type(epithelioid)
Associate nevus(not identified)
Lymphocytic infiltrate(non-brisk)
4. Is there a chance that the bad cells have spread to other parts of the body, because the initial punch biopsy cut into the tumor? One of the surgeons who did the surgery(a resident) mentioned it. This makes me really scared.
The whole medical process seems to be very disorganised and it is very confusing and disappointing. I live in an Asian country where skin tumors are very rare and my husband is a Caucasian. I couldn’t find any information on these anywhere in my native language. I will really appreciate your help. Thank you very much for reading this long post.
- Replies
-
-
- May 29, 2013 at 4:44 am
Lentigo Maligna is a sub-type of melanoma. Lentigo Maligna is used when it is confined to the epidermis. Lentigo Maligna Melanoma is used when the lesion is invasive (deeper than Clark's Level 1). So I read this as being Lentigo Maligna and stage 0 — typically called in situ with the other sub-types of melanoma.
I do not understand the surgeon's statements. Lentigo Maligna is essentially "melanoma in situ" – melanoma confined to the epidermis. There is no need for scans and I don't understand why the parotid gland should be removed. I'm certainly no ENT but the typical scenario is a wide excision and that is it. No scans, no other tests. Maybe there is something about the area that is unique but the standard of care seems more along the lines of what your dermatologist told you.
As for your question 3, you are deciphering basic items of the path report. None of these are really prognostic in nature so not much help in understanding the lesion.
Biopsies are done all the time without getting clean margins. If that were to cause metastasis, it would have been discovered long before now.
I think that being in an Asian country is possibly the reason for some confusion. Melanoma isn't seen among that population nearly as much as Caucasion. I, personally, would probably be looking for another surgical opinion as from my point of view, the surgeon seems extremely aggressive beyond what appears warranted. Are there any melanoma specialists nearby? I'm not sure how far you are from Australia or if that were even an option, but melanoma is treated regularly there. Maybe there could be some type of phone consult?
Best wishes,
Janner
-
- May 29, 2013 at 6:24 am
Thank you very much for your kind, prompt, well-organized and very helpful reply. We live in South Korea and being so far away, it would have been very complicated to deal with this in Australia anyway, although we wouldn’t have had to experience all this confusion. Dermatologists not wanting to be involved in the decision-making, surgeons contradicting the dermatologist and even themselves, and time passing waiting for all the tests and the results thereof, it was a very stressful chaos.
The wide excision surgery was already done with >1cm margins followed by a PET- CT scan(our second surgeon also prescribed this) and a neck-sonogram to check if tumor spread to the parotid gland, which turned out to be clear. I wouldn’t mind getting another opinion on this, though, if there is long-distance consult available, as I don’t see there is any melanoma specialist who is willing to be involved where we are. Is there any recommendation?
So, my understanding is, if it is Clark level 1, it is called "lentigo maligna", not “lentigo maligna melanoma” or "lentigo malinant melanoma"?
Thank you again for your help.
-
- May 29, 2013 at 1:45 pm
In terms of treatment, you've had way more than would most likely be done in Australia or the US. A PET/CT would never be done for something so early here in the US. You can't see microscopic disease on a scan and Lentigo Maligna (being confined to the epidermis) really doesn't have any blood vessels or lymph vessels in that layer to aid spreading. I could see a sonogram possibly being done but that's it. However, I will warn you of one thing. Lentigo Maligna has the highest LOCAL recurrence rate. It's not always easy to get good margins. So please keep an eye out for any additional pigment regrowth at the WLE location. You'd want to get that taken care of if anything pops up.
Yes, your understanding is correct. That is how it is termed here butI don't believe this is something that everyone agrees upon or is universal. Sometimes these terms are used loosely and some may include "melanoma", some not. But this explanation is more consistent with your derms explanation of "precancer" because it is NOT considered "invasive" at this point (Clark's Level I). It becomes "invasive" when it penetrates the epidermis into the dermis (Clark's Level II+)
-
- May 29, 2013 at 1:45 pm
In terms of treatment, you've had way more than would most likely be done in Australia or the US. A PET/CT would never be done for something so early here in the US. You can't see microscopic disease on a scan and Lentigo Maligna (being confined to the epidermis) really doesn't have any blood vessels or lymph vessels in that layer to aid spreading. I could see a sonogram possibly being done but that's it. However, I will warn you of one thing. Lentigo Maligna has the highest LOCAL recurrence rate. It's not always easy to get good margins. So please keep an eye out for any additional pigment regrowth at the WLE location. You'd want to get that taken care of if anything pops up.
Yes, your understanding is correct. That is how it is termed here butI don't believe this is something that everyone agrees upon or is universal. Sometimes these terms are used loosely and some may include "melanoma", some not. But this explanation is more consistent with your derms explanation of "precancer" because it is NOT considered "invasive" at this point (Clark's Level I). It becomes "invasive" when it penetrates the epidermis into the dermis (Clark's Level II+)
-
- May 29, 2013 at 1:45 pm
In terms of treatment, you've had way more than would most likely be done in Australia or the US. A PET/CT would never be done for something so early here in the US. You can't see microscopic disease on a scan and Lentigo Maligna (being confined to the epidermis) really doesn't have any blood vessels or lymph vessels in that layer to aid spreading. I could see a sonogram possibly being done but that's it. However, I will warn you of one thing. Lentigo Maligna has the highest LOCAL recurrence rate. It's not always easy to get good margins. So please keep an eye out for any additional pigment regrowth at the WLE location. You'd want to get that taken care of if anything pops up.
Yes, your understanding is correct. That is how it is termed here butI don't believe this is something that everyone agrees upon or is universal. Sometimes these terms are used loosely and some may include "melanoma", some not. But this explanation is more consistent with your derms explanation of "precancer" because it is NOT considered "invasive" at this point (Clark's Level I). It becomes "invasive" when it penetrates the epidermis into the dermis (Clark's Level II+)
-
- May 29, 2013 at 6:24 am
Thank you very much for your kind, prompt, well-organized and very helpful reply. We live in South Korea and being so far away, it would have been very complicated to deal with this in Australia anyway, although we wouldn’t have had to experience all this confusion. Dermatologists not wanting to be involved in the decision-making, surgeons contradicting the dermatologist and even themselves, and time passing waiting for all the tests and the results thereof, it was a very stressful chaos.
The wide excision surgery was already done with >1cm margins followed by a PET- CT scan(our second surgeon also prescribed this) and a neck-sonogram to check if tumor spread to the parotid gland, which turned out to be clear. I wouldn’t mind getting another opinion on this, though, if there is long-distance consult available, as I don’t see there is any melanoma specialist who is willing to be involved where we are. Is there any recommendation?
So, my understanding is, if it is Clark level 1, it is called "lentigo maligna", not “lentigo maligna melanoma” or "lentigo malinant melanoma"?
Thank you again for your help.
-
- May 29, 2013 at 6:24 am
Thank you very much for your kind, prompt, well-organized and very helpful reply. We live in South Korea and being so far away, it would have been very complicated to deal with this in Australia anyway, although we wouldn’t have had to experience all this confusion. Dermatologists not wanting to be involved in the decision-making, surgeons contradicting the dermatologist and even themselves, and time passing waiting for all the tests and the results thereof, it was a very stressful chaos.
The wide excision surgery was already done with >1cm margins followed by a PET- CT scan(our second surgeon also prescribed this) and a neck-sonogram to check if tumor spread to the parotid gland, which turned out to be clear. I wouldn’t mind getting another opinion on this, though, if there is long-distance consult available, as I don’t see there is any melanoma specialist who is willing to be involved where we are. Is there any recommendation?
So, my understanding is, if it is Clark level 1, it is called "lentigo maligna", not “lentigo maligna melanoma” or "lentigo malinant melanoma"?
Thank you again for your help.
-
- May 29, 2013 at 4:44 am
Lentigo Maligna is a sub-type of melanoma. Lentigo Maligna is used when it is confined to the epidermis. Lentigo Maligna Melanoma is used when the lesion is invasive (deeper than Clark's Level 1). So I read this as being Lentigo Maligna and stage 0 — typically called in situ with the other sub-types of melanoma.
I do not understand the surgeon's statements. Lentigo Maligna is essentially "melanoma in situ" – melanoma confined to the epidermis. There is no need for scans and I don't understand why the parotid gland should be removed. I'm certainly no ENT but the typical scenario is a wide excision and that is it. No scans, no other tests. Maybe there is something about the area that is unique but the standard of care seems more along the lines of what your dermatologist told you.
As for your question 3, you are deciphering basic items of the path report. None of these are really prognostic in nature so not much help in understanding the lesion.
Biopsies are done all the time without getting clean margins. If that were to cause metastasis, it would have been discovered long before now.
I think that being in an Asian country is possibly the reason for some confusion. Melanoma isn't seen among that population nearly as much as Caucasion. I, personally, would probably be looking for another surgical opinion as from my point of view, the surgeon seems extremely aggressive beyond what appears warranted. Are there any melanoma specialists nearby? I'm not sure how far you are from Australia or if that were even an option, but melanoma is treated regularly there. Maybe there could be some type of phone consult?
Best wishes,
Janner
-
- May 29, 2013 at 4:44 am
Lentigo Maligna is a sub-type of melanoma. Lentigo Maligna is used when it is confined to the epidermis. Lentigo Maligna Melanoma is used when the lesion is invasive (deeper than Clark's Level 1). So I read this as being Lentigo Maligna and stage 0 — typically called in situ with the other sub-types of melanoma.
I do not understand the surgeon's statements. Lentigo Maligna is essentially "melanoma in situ" – melanoma confined to the epidermis. There is no need for scans and I don't understand why the parotid gland should be removed. I'm certainly no ENT but the typical scenario is a wide excision and that is it. No scans, no other tests. Maybe there is something about the area that is unique but the standard of care seems more along the lines of what your dermatologist told you.
As for your question 3, you are deciphering basic items of the path report. None of these are really prognostic in nature so not much help in understanding the lesion.
Biopsies are done all the time without getting clean margins. If that were to cause metastasis, it would have been discovered long before now.
I think that being in an Asian country is possibly the reason for some confusion. Melanoma isn't seen among that population nearly as much as Caucasion. I, personally, would probably be looking for another surgical opinion as from my point of view, the surgeon seems extremely aggressive beyond what appears warranted. Are there any melanoma specialists nearby? I'm not sure how far you are from Australia or if that were even an option, but melanoma is treated regularly there. Maybe there could be some type of phone consult?
Best wishes,
Janner
-
Tagged: cutaneous melanoma
- You must be logged in to reply to this topic.