desparate need of help with path report

Severely atypical lesions might technically be benign, but they are as close to melanoma in situ as you can get and still be "benign".  Even then, it's usually recommended to have 5mm margins on severely atypical lesions — just like melanoma in situ (cancer).  It can be a fine line distinguishing between the two diagnosis — but the treatment is actually the same.  There is no black and white between melanoma in situ and severely atypical.  One doc might say cancer, the other benign.  Basically, they look at a bunch of factors present and decide how atypical each one is.  Then they come up with a consensus.  So, if you think of a scale from 1-10 and 10 is melanoma in situ, a severely atypical lesion could be anywhere from a 7-9.9.   One factor might say cancer while another one says "atypical".  Add them all up and what do you get?  Pathology is not an exact science and much depends on the experience of the pathologist.

So, now back to your original question, should you have the extra margins taken if you have severely atypical cells at the margins?  If it were me, I'd say yes.  To date, the very BEST "cure" for melanoma is surgery at the original site.  Ears are higher risk areas and getting it all now seems to me to be the best way to go.  This is my opinion.  You have to make the final determination on what works best for YOU.  No insurance sucks, but it would be even harder later to pay for treatments ($$$$$$), etc., if this were to spread. 

Best wishes,

Janner

Severely atypical lesions might technically be benign, but they are as close to melanoma in situ as you can get and still be "benign".  Even then, it's usually recommended to have 5mm margins on severely atypical lesions — just like melanoma in situ (cancer).  It can be a fine line distinguishing between the two diagnosis — but the treatment is actually the same.  There is no black and white between melanoma in situ and severely atypical.  One doc might say cancer, the other benign.  Basically, they look at a bunch of factors present and decide how atypical each one is.  Then they come up with a consensus.  So, if you think of a scale from 1-10 and 10 is melanoma in situ, a severely atypical lesion could be anywhere from a 7-9.9.   One factor might say cancer while another one says "atypical".  Add them all up and what do you get?  Pathology is not an exact science and much depends on the experience of the pathologist.

So, now back to your original question, should you have the extra margins taken if you have severely atypical cells at the margins?  If it were me, I'd say yes.  To date, the very BEST "cure" for melanoma is surgery at the original site.  Ears are higher risk areas and getting it all now seems to me to be the best way to go.  This is my opinion.  You have to make the final determination on what works best for YOU.  No insurance sucks, but it would be even harder later to pay for treatments ($$$$$$), etc., if this were to spread. 

Best wishes,

Janner

Severely atypical lesions might technically be benign, but they are as close to melanoma in situ as you can get and still be "benign".  Even then, it's usually recommended to have 5mm margins on severely atypical lesions — just like melanoma in situ (cancer).  It can be a fine line distinguishing between the two diagnosis — but the treatment is actually the same.  There is no black and white between melanoma in situ and severely atypical.  One doc might say cancer, the other benign.  Basically, they look at a bunch of factors present and decide how atypical each one is.  Then they come up with a consensus.  So, if you think of a scale from 1-10 and 10 is melanoma in situ, a severely atypical lesion could be anywhere from a 7-9.9.   One factor might say cancer while another one says "atypical".  Add them all up and what do you get?  Pathology is not an exact science and much depends on the experience of the pathologist.

So, now back to your original question, should you have the extra margins taken if you have severely atypical cells at the margins?  If it were me, I'd say yes.  To date, the very BEST "cure" for melanoma is surgery at the original site.  Ears are higher risk areas and getting it all now seems to me to be the best way to go.  This is my opinion.  You have to make the final determination on what works best for YOU.  No insurance sucks, but it would be even harder later to pay for treatments ($$$$$$), etc., if this were to spread. 

Best wishes,

Janner

Janner, your reply revolves around the opening poster having a severely atypical lesion versus melanoma in situ.  The differential diagnosis, however, was a stage 1a melanoma of 0.8mm in depth which is not melanoma in situ.

Janner, your reply revolves around the opening poster having a severely atypical lesion versus melanoma in situ.  The differential diagnosis, however, was a stage 1a melanoma of 0.8mm in depth which is not melanoma in situ.

Janner, your reply revolves around the opening poster having a severely atypical lesion versus melanoma in situ.  The differential diagnosis, however, was a stage 1a melanoma of 0.8mm in depth which is not melanoma in situ.

Because your lesion is stage IA (no mitosis), they don't usually do a SNB.  If this was stage IB, it would be questionable given the depth.  However, more places are doing the SNB for stage IB lesions regardless of depth.  In addition, it typically needs to be done PRIOR to the WLE.  There's little question about where the ear drains to, but you may not get the original sentinel node that you might have been prior to the WLE.

Because your lesion is stage IA (no mitosis), they don't usually do a SNB.  If this was stage IB, it would be questionable given the depth.  However, more places are doing the SNB for stage IB lesions regardless of depth.  In addition, it typically needs to be done PRIOR to the WLE.  There's little question about where the ear drains to, but you may not get the original sentinel node that you might have been prior to the WLE.

Because your lesion is stage IA (no mitosis), they don't usually do a SNB.  If this was stage IB, it would be questionable given the depth.  However, more places are doing the SNB for stage IB lesions regardless of depth.  In addition, it typically needs to be done PRIOR to the WLE.  There's little question about where the ear drains to, but you may not get the original sentinel node that you might have been prior to the WLE.

I know the lesion was stage IA, but he is asking about the residual neoplasm and asking if that is cancer or benign.   I was trying to explain the difference or similarities between the two and what is typically done with each.

I've never had it clarified to me what should be done if a stage I lesion is removed but there is residual in situ at the margins.  Do you take stage I  or in situ margins for the WLE.  I've seen posts on here that seem to go both ways, but this is still unclear in my mind as to what makes sense.  For me, there is no question on what I'd do if I were the original poster.  He doesn't have clear enough margins from the removed melanoma to be safe.  He doesn't have the 1 cm (stage I) or 5mm (in situ / severely atypical) minimum margins from cancerous (or nearly) cells.  Being without insurance certainly makes us question things which might be "optional" and I understand the reason he asked the question.  But this wouldn't be optional in my book.

Thanks for raising the point, however, because you are right, I didn't address the stage I issue and wouldn't want to add any confusion.

Best wishes,

Janner

I know the lesion was stage IA, but he is asking about the residual neoplasm and asking if that is cancer or benign.   I was trying to explain the difference or similarities between the two and what is typically done with each.

I've never had it clarified to me what should be done if a stage I lesion is removed but there is residual in situ at the margins.  Do you take stage I  or in situ margins for the WLE.  I've seen posts on here that seem to go both ways, but this is still unclear in my mind as to what makes sense.  For me, there is no question on what I'd do if I were the original poster.  He doesn't have clear enough margins from the removed melanoma to be safe.  He doesn't have the 1 cm (stage I) or 5mm (in situ / severely atypical) minimum margins from cancerous (or nearly) cells.  Being without insurance certainly makes us question things which might be "optional" and I understand the reason he asked the question.  But this wouldn't be optional in my book.

Thanks for raising the point, however, because you are right, I didn't address the stage I issue and wouldn't want to add any confusion.

Best wishes,

Janner

I know the lesion was stage IA, but he is asking about the residual neoplasm and asking if that is cancer or benign.   I was trying to explain the difference or similarities between the two and what is typically done with each.

I've never had it clarified to me what should be done if a stage I lesion is removed but there is residual in situ at the margins.  Do you take stage I  or in situ margins for the WLE.  I've seen posts on here that seem to go both ways, but this is still unclear in my mind as to what makes sense.  For me, there is no question on what I'd do if I were the original poster.  He doesn't have clear enough margins from the removed melanoma to be safe.  He doesn't have the 1 cm (stage I) or 5mm (in situ / severely atypical) minimum margins from cancerous (or nearly) cells.  Being without insurance certainly makes us question things which might be "optional" and I understand the reason he asked the question.  But this wouldn't be optional in my book.

Thanks for raising the point, however, because you are right, I didn't address the stage I issue and wouldn't want to add any confusion.

Best wishes,

Janner