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Confirmed by 2nd Path, it is Melanoma

Forums Confirmed by 2nd Path, it is Melanoma

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      Hi there internet support system 🙂 I just wanted to pop over and give you an update. In an earlier post I mentioned I’d initially been diagnosed with .9mm melanoma of the scalp, at least 1b. When that path/slides were send to the hospital that’s performing my surgery/treatment, their dermatopathologists weren’t convinced and wanted to run more tests and stains. Welp, as expected, I got the second path report back and it IS melanoma. My new surgery date is 11/30 (next Monday).. (it was originally supposed to be 11/17 but they post-poned to run these additional tests).

      There was more detail in this path report that was just uploaded to my patient site and I’m wondering if anyone can help interpret..

      “There is a proliferation of enlarged melanocytes arranged as solitary units and as nests within the epidermis, at the dermo-epidermal junction and there are occasional solitary units above it. Additionally, there is focal crowding and confluence of melanocytes at the dermo-epidermal junction. Within the dermis, there are nests of melanocytes that show maturation, however, there is also a large collection of atypical enlarged melanocytes arranged as sheets. Within this area, there are several atypical mitotic figures, and there is lack of maturation of melanocytes. A MART-1/Ki-67 stain performed at the Washington University Dermatopathology Center shows an increased proliferative rate within this area, although the remainder of the lesion does not show significant Ki-67 staining. (C43.9)”

      This last part below I pretty much know how to interpret, but just including for anyone curious!

      “Histologic Type: Malignant melanoma, NOS
      Breslow Depth: At least 0.9mm
      Ulceration: Not identified
      Mitotic rate: None identified
      Microsatellitosis: Not identified
      Lymphovascular Invasion: Not identified
      Neurotropism: Not identified
      Tumor-infiltrating Lymphocytes: Present, brisk
      Tumor Regression: Present
      Peripheral Margins:
      Involved by invasive melanoma
      Deep Margins:
      Involved by invasive melanoma

      Pathologic Staging:
      Primary Tumor (pT): at least pT1b”

      Ultimately I’m just hoping for some positive vibes going into surgery next week.

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          I m not a doctor. This sentence
          Within this area, there are several atypical mitotic figures, and there is lack of maturation of melanocytes and the other one

          Center shows an increased proliferative rate within this area, although the remainder of the lesion does not show significant Ki-67 staining. (C43.9)”

          Tells me that it’s is beginning of melanoma formation.
          If I was you I would be curious to ask them if there is anything else as early as this can tell about melanoma development.
          You should be ok after having it removed.

            Hi there just wanted to pop back in and follow up. I had my WLE and SLNB on 11/30. They were able to get clear margins and removed about 10 lymph nodes, all came back negative. What was left in what was excised was just residual melanoma in-situ, so it seems like the originals biopsy on diagnosis got most of it out at .9mm, but with regression present I suppose we will never know true depth.

            so, best possible news for me. I think I am 1b? I will have follow ups with the surgical oncologist for five years and regular skin checks with my derm. They are nit offering any scans for me. Is there anything else I can or should ask for? I am absolutely terrified of recurrence and that there’s really not much I can do other than “wait and see” ????

              Hi JW,

              I have been going to my derm every 3 months since 2A diagnosis in 2017. Then suddenly in June 2020 between visits, two subcutaneous lumps popped up- one in my armpit, and other on my L flank. My derm ordered the biopsy at my breast care center and it came back metastatic melanoma. I was supposed to be low risk (the Castle test said so)!!!

              Many people self-identify spots and lumps, so self-skin exams plus your followups are a great plan. I also keep up with the latest research and treatment for melanoma to help me understand this disease. Best wishes, Cindy

                The Breslow depth is very encouraging. Wishing you a great recovery from the surgery.
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