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Confused…Shave Biospy vs Excision Pathology???
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Confused…Shave Biospy vs Excision Pathology???

› Forums › General Melanoma Community › Confused…Shave Biospy vs Excision Pathology???

  • Post
    • March 15, 2016 at 5:42 pm
    msnow
    Participant

      My ten year old daughter had this mole on her upper back since she was very young but over the past couple of years it had been scraped by her brushing her hair and she also picked at it when she was younger so it changed shape a bit.  Had it checked by one dermatologist years ago who said its nothing… Recently had another dermatologist check the mole and we decided to go ahead with a shave biopsy.  The pathology results: compound nevus with minimally to focally moderate atypica. Complete excision recommended.  

      Our dermatologist basically said no big deal lets just make sure we get all clear margins with minimal scaring and since she doesn't do stitches referred us out to a plastic surgeon.  So we waited 2 months for an available appointment.  We went to the plastic surgeon yesterday who excised the mole and stated the mole was deep and he was making sure to get enough in case melanoma was present.  I was a bit taken back and respectfully questioned why he thought  melanoma was present when the biopsy pathology never mentioned it.  He said it can happen especially when the pathologist gets the larger sample rather than the shave.  Ok… now I'm nervous!!!!

      Should I expect such a drastic change in pathology results from the excision to upstage from mild to moderate atypical to melanoma?  I am assuming the pathologist who read the shave biopsy would have mentioned melanoma concerns or maybe the shave biopsy didn't give him enough to make a concrete finding of melanoma?  i was told the same dermatopathologist who read the shave biopsy will also read the excision.  Plus in the shave biopsy pathology report there is a mention of a stromal inflammation response…not quite sure what that means.  Thanks 

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        • March 15, 2016 at 7:58 pm
        Janner
        Participant

          I would ABSOLUTELY NOT be worried.  Since melanoma basically grows from the top of the skin down, the likelihood of finding something at the deepest portion that is worse than the top of the lesion is just extremely unlikely.  I don't think that was an appropriate comment to make to you – especially when the lesion wasn't remotely melanoma.  The pathology slides will be read again and I think you will see scar tissue along with a similar diagnosis.  Honestly, don't go there because I can't see this as being a problem.

            • March 15, 2016 at 10:10 pm
            msnow
            Participant

              Janner…Thank you very much for your kind reply.  

              That's what I thought… This is a mole which needs to be fully excised but nothing remotely close to melanoma.  Out of curiosity from your knowledge and experience would a dermatopologist be able to clearly decipher a melanoma from atypical cells from a shave biopsy?  

              And I have been trying to find the meaning of this sentence from the pathology report. "Minimal to focally moderate random cytoloical atypica, are arranged in a somewhat haphazard configuration and a accompanied by the subjacent reactive inflammatory response".  Not putting to much effort into the overall microspcopic description but was just curious as I am thinking this could be from the past trauma to the mole.  

              Thanks again for your encouraging comments as my daughter also heard the comment the surgeon made and is now somewhat anxious… I told her power is in knowledge and went over the biopsy pathology report with her.  Thankfully the mole has been excised and now as a family we will be more diligent with sun protection, skin checks without being overly paranoid.  

              • March 15, 2016 at 10:18 pm
              Janner
              Participant

                Shave biopsies are perfectly fine for diagnosing.  They just have a nasty little habit of being too shallow to remove the entire lesion.  But no worries on the diagnosis portion.

                The path sentence is basically describing the layout of the melanocytes – essentially justifying the final diagnosis.  There is no prognostic value or anything you can really take from it.  The trauma could certainly be a cause, but it would only be speculation on anyone's part.

                Yes, not too keen on bedside manner with that surgeon – and sun protection is very important.  Watch moles for CHANGE and be your own best advocate!

                • March 15, 2016 at 10:18 pm
                Janner
                Participant

                  Shave biopsies are perfectly fine for diagnosing.  They just have a nasty little habit of being too shallow to remove the entire lesion.  But no worries on the diagnosis portion.

                  The path sentence is basically describing the layout of the melanocytes – essentially justifying the final diagnosis.  There is no prognostic value or anything you can really take from it.  The trauma could certainly be a cause, but it would only be speculation on anyone's part.

                  Yes, not too keen on bedside manner with that surgeon – and sun protection is very important.  Watch moles for CHANGE and be your own best advocate!

                  • March 15, 2016 at 10:18 pm
                  Janner
                  Participant

                    Shave biopsies are perfectly fine for diagnosing.  They just have a nasty little habit of being too shallow to remove the entire lesion.  But no worries on the diagnosis portion.

                    The path sentence is basically describing the layout of the melanocytes – essentially justifying the final diagnosis.  There is no prognostic value or anything you can really take from it.  The trauma could certainly be a cause, but it would only be speculation on anyone's part.

                    Yes, not too keen on bedside manner with that surgeon – and sun protection is very important.  Watch moles for CHANGE and be your own best advocate!

                    • March 15, 2016 at 10:10 pm
                    msnow
                    Participant

                      Janner…Thank you very much for your kind reply.  

                      That's what I thought… This is a mole which needs to be fully excised but nothing remotely close to melanoma.  Out of curiosity from your knowledge and experience would a dermatopologist be able to clearly decipher a melanoma from atypical cells from a shave biopsy?  

                      And I have been trying to find the meaning of this sentence from the pathology report. "Minimal to focally moderate random cytoloical atypica, are arranged in a somewhat haphazard configuration and a accompanied by the subjacent reactive inflammatory response".  Not putting to much effort into the overall microspcopic description but was just curious as I am thinking this could be from the past trauma to the mole.  

                      Thanks again for your encouraging comments as my daughter also heard the comment the surgeon made and is now somewhat anxious… I told her power is in knowledge and went over the biopsy pathology report with her.  Thankfully the mole has been excised and now as a family we will be more diligent with sun protection, skin checks without being overly paranoid.  

                      • March 15, 2016 at 10:10 pm
                      msnow
                      Participant

                        Janner…Thank you very much for your kind reply.  

                        That's what I thought… This is a mole which needs to be fully excised but nothing remotely close to melanoma.  Out of curiosity from your knowledge and experience would a dermatopologist be able to clearly decipher a melanoma from atypical cells from a shave biopsy?  

                        And I have been trying to find the meaning of this sentence from the pathology report. "Minimal to focally moderate random cytoloical atypica, are arranged in a somewhat haphazard configuration and a accompanied by the subjacent reactive inflammatory response".  Not putting to much effort into the overall microspcopic description but was just curious as I am thinking this could be from the past trauma to the mole.  

                        Thanks again for your encouraging comments as my daughter also heard the comment the surgeon made and is now somewhat anxious… I told her power is in knowledge and went over the biopsy pathology report with her.  Thankfully the mole has been excised and now as a family we will be more diligent with sun protection, skin checks without being overly paranoid.  

                      • March 15, 2016 at 7:58 pm
                      Janner
                      Participant

                        I would ABSOLUTELY NOT be worried.  Since melanoma basically grows from the top of the skin down, the likelihood of finding something at the deepest portion that is worse than the top of the lesion is just extremely unlikely.  I don't think that was an appropriate comment to make to you – especially when the lesion wasn't remotely melanoma.  The pathology slides will be read again and I think you will see scar tissue along with a similar diagnosis.  Honestly, don't go there because I can't see this as being a problem.

                        • March 15, 2016 at 7:58 pm
                        Janner
                        Participant

                          I would ABSOLUTELY NOT be worried.  Since melanoma basically grows from the top of the skin down, the likelihood of finding something at the deepest portion that is worse than the top of the lesion is just extremely unlikely.  I don't think that was an appropriate comment to make to you – especially when the lesion wasn't remotely melanoma.  The pathology slides will be read again and I think you will see scar tissue along with a similar diagnosis.  Honestly, don't go there because I can't see this as being a problem.

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