› Forums › General Melanoma Community › Confusion over my diagnosis
- This topic has 24 replies, 2 voices, and was last updated 8 years ago by
lakegirl67.
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- April 13, 2016 at 10:08 pm
It all started by visiting my Derm for the first time in 6 years for a full body check up. I'm 49 with a a lot of sun damge and regrettably used tanning beds as a teen. He didn't like the look of a "freckle" on my neck. He did a shave biopsy and here is the report:
Gross desription: a shaved portion of skin is received, inked for margins and submitted complete in one cassette with transverse sections taken. .9x.9x.1cm
Microscopic exam: there is a proliferation of atypical melanocytes within the basal layer. Some of these cells are seen migrating upward through the epithelium. These are changes seen in melanoma-in-situ arising within a dysplastic nevus. The lesion is completely excised.
Note: although excised, reexcision is recommended.
Diagnosis: Atypical melanocytic hyperplasia (melanoma in situ) arising within a dysplastic nevus, completely excised. (SEE NOTE)
My Dr. was on vacation so another Dr in the practice gave me the news and assured me that this was "NOT a melanoma" and that "This added diagnosis was added by the pathologist to ensure that it would be treated as a melanoma in situ but your mole does not have all the criteria needed to make the diagnosis of melanoma.I realize that sounds odd, keep in mind the pathologists intent is to ensure adequate treatment."
So an appt was set up for yesterday with my Dr. to have the WLE. When I met with him, he told me that it was melanoma in situ and that the pathologist was using "old terminolgy". What the heck?? I went through with the procedure because the treatment is is the same for either AMH & MIS. I think he did 8mm margins and I have a 4 inch incision on my front neck area!
He reassured me that this would take care of it, but I am not so sure I feel reassured about anything right now. I'm scared that these results will show something more sinister. I fear that there will be a reoccurance and I have a lot of questions. Can anyone offer advice. Why the difference in interpreting the path report? I called the path lab today but they won't let me talk to a path. I want to know because it matters to ME if this a Melanoma diagnosis or not!! Am I missing anything? Does this seem like a good path report in terms of info provided? Thanks!
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- April 14, 2016 at 2:49 am
So the lesion was completely excised with the biopsy so the WLE report won't show anything different. If you want clarification, I think the only way you can do that is send the slides for a second opinion to a different dermatopathologist. Please understand that it is a fine line between a severely atypical lesion and melanoma in situ and different pathologists might have different opinions on when a lesion crosses the line. That is why the treatment is the same. If I were reading the report, I see the words melanoma in situ and that is what I have to go with. I can't just dismiss those written words and say severely atypical lesion regardless of old or new terminology.
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- April 14, 2016 at 2:49 am
So the lesion was completely excised with the biopsy so the WLE report won't show anything different. If you want clarification, I think the only way you can do that is send the slides for a second opinion to a different dermatopathologist. Please understand that it is a fine line between a severely atypical lesion and melanoma in situ and different pathologists might have different opinions on when a lesion crosses the line. That is why the treatment is the same. If I were reading the report, I see the words melanoma in situ and that is what I have to go with. I can't just dismiss those written words and say severely atypical lesion regardless of old or new terminology.
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- April 14, 2016 at 8:56 pm
Janner, thank you for your reply. I am still awaiting the results of the biopsy report of the WLE which I should get tomorrow. Do you think that it was bad that my initial biopsy was a shave of the lesion since I was then diagnosed with MIS? He removed the entire mole with the shave. He told me that there would be no surprises with the MLE biopsy report and that everything was removed. I am so worried that the initial biopsy wasn't deep enough. Could the "completely excised" mean that the mole was completely excised and no be referring to the MIS lesion?
Thank you.
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- April 14, 2016 at 8:56 pm
Janner, thank you for your reply. I am still awaiting the results of the biopsy report of the WLE which I should get tomorrow. Do you think that it was bad that my initial biopsy was a shave of the lesion since I was then diagnosed with MIS? He removed the entire mole with the shave. He told me that there would be no surprises with the MLE biopsy report and that everything was removed. I am so worried that the initial biopsy wasn't deep enough. Could the "completely excised" mean that the mole was completely excised and no be referring to the MIS lesion?
Thank you.
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- April 14, 2016 at 8:56 pm
Janner, thank you for your reply. I am still awaiting the results of the biopsy report of the WLE which I should get tomorrow. Do you think that it was bad that my initial biopsy was a shave of the lesion since I was then diagnosed with MIS? He removed the entire mole with the shave. He told me that there would be no surprises with the MLE biopsy report and that everything was removed. I am so worried that the initial biopsy wasn't deep enough. Could the "completely excised" mean that the mole was completely excised and no be referring to the MIS lesion?
Thank you.
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- April 14, 2016 at 9:52 pm
Completely excised means there were clear margins around the entire lesion. The mole was completely removed with the biopsy, and with it, all the melanoma. There is no issue with a shave biopsy, shaves are only problematic if they bisect a lesion. That didn't happen here. Shaves are ALWAYS deep enough to diagnose melanoma in situ accurately. It is just when a lesion is deeper and the shave bisects the lesion that there are staging issues.
The WLE report will have nothing new, you already have your complete diagnosis. The WLE will only confirm that there is no melanoma present – already known given clean margins.
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- April 14, 2016 at 9:52 pm
Completely excised means there were clear margins around the entire lesion. The mole was completely removed with the biopsy, and with it, all the melanoma. There is no issue with a shave biopsy, shaves are only problematic if they bisect a lesion. That didn't happen here. Shaves are ALWAYS deep enough to diagnose melanoma in situ accurately. It is just when a lesion is deeper and the shave bisects the lesion that there are staging issues.
The WLE report will have nothing new, you already have your complete diagnosis. The WLE will only confirm that there is no melanoma present – already known given clean margins.
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- April 14, 2016 at 9:52 pm
Completely excised means there were clear margins around the entire lesion. The mole was completely removed with the biopsy, and with it, all the melanoma. There is no issue with a shave biopsy, shaves are only problematic if they bisect a lesion. That didn't happen here. Shaves are ALWAYS deep enough to diagnose melanoma in situ accurately. It is just when a lesion is deeper and the shave bisects the lesion that there are staging issues.
The WLE report will have nothing new, you already have your complete diagnosis. The WLE will only confirm that there is no melanoma present – already known given clean margins.
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- April 14, 2016 at 10:02 pm
Thank you Janner and bless you. I might actually sleep tonight.
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- April 14, 2016 at 10:02 pm
Thank you Janner and bless you. I might actually sleep tonight.
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- April 14, 2016 at 10:02 pm
Thank you Janner and bless you. I might actually sleep tonight.
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- April 18, 2016 at 12:59 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 12:59 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 12:59 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:23 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:23 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:23 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:24 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:24 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 18, 2016 at 1:24 pm
You were right – clear margins!
I have read that head and neck melanomas have a worse prognosis. Since my MIS was on my neck, how does this affect my prognosis?
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- April 22, 2016 at 8:17 pm
The path report from the WLE showed "no residual atypical melanocytic hyperplasia (melanoma in siru) within the re-excised tissue." Dr. took 8 mm margins. Since the procedure, I have read that MIS on the neck should be treated with wider margins. Can anyone please tell me if this is correct or recommended? My Dr. said not to worry, but I am second guessing everything and want to have the best possible outcome with this MIS and WLE on my neck. I also showed him two other moles under my underwear line that he did not see during the full body because I left my underwear on. He wants to remove them the middle of April after I return from vacation. He said he isn't overly concerned and just taking precautions and guessing may be dysplastic. I am a mess. Thanks for any input you can give.
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- April 22, 2016 at 8:17 pm
The path report from the WLE showed "no residual atypical melanocytic hyperplasia (melanoma in siru) within the re-excised tissue." Dr. took 8 mm margins. Since the procedure, I have read that MIS on the neck should be treated with wider margins. Can anyone please tell me if this is correct or recommended? My Dr. said not to worry, but I am second guessing everything and want to have the best possible outcome with this MIS and WLE on my neck. I also showed him two other moles under my underwear line that he did not see during the full body because I left my underwear on. He wants to remove them the middle of April after I return from vacation. He said he isn't overly concerned and just taking precautions and guessing may be dysplastic. I am a mess. Thanks for any input you can give.
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- April 22, 2016 at 8:17 pm
The path report from the WLE showed "no residual atypical melanocytic hyperplasia (melanoma in siru) within the re-excised tissue." Dr. took 8 mm margins. Since the procedure, I have read that MIS on the neck should be treated with wider margins. Can anyone please tell me if this is correct or recommended? My Dr. said not to worry, but I am second guessing everything and want to have the best possible outcome with this MIS and WLE on my neck. I also showed him two other moles under my underwear line that he did not see during the full body because I left my underwear on. He wants to remove them the middle of April after I return from vacation. He said he isn't overly concerned and just taking precautions and guessing may be dysplastic. I am a mess. Thanks for any input you can give.
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- April 14, 2016 at 2:49 am
So the lesion was completely excised with the biopsy so the WLE report won't show anything different. If you want clarification, I think the only way you can do that is send the slides for a second opinion to a different dermatopathologist. Please understand that it is a fine line between a severely atypical lesion and melanoma in situ and different pathologists might have different opinions on when a lesion crosses the line. That is why the treatment is the same. If I were reading the report, I see the words melanoma in situ and that is what I have to go with. I can't just dismiss those written words and say severely atypical lesion regardless of old or new terminology.
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Tagged: cutaneous melanoma
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