› Forums › General Melanoma Community › Difference between local recurrence and new primary?
- This topic has 30 replies, 4 voices, and was last updated 7 years, 3 months ago by
Janner.
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- January 19, 2017 at 7:19 pm
Hi all,
Viewing my mom's pathology report and in the comments it says:
The differential diagnosis includes a new primary of nodular melanoma vs. a focus of recurrent or in transit metastatic disease. Correlation of the biopsy site to previous excision site may be helpful.
Can anybody decipher what this means?
The new melanoma is .8mm, no miotic, no ulceration within the superficial dermis.
We are waiting to meet with an oncologist.
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- January 19, 2017 at 8:20 pm
Believe me Selle7, I am no expert on this. Because my daughter Julie has has been diagnosed with Stage 3, I am new here, but have found this forum to be so supportive. I am sure others will respond, who I know will have more insight then me. In any case, from what I see, I believe the report is saying most likely that this is a new primary and not a recurrent. the fact. that it is .8mm, no mitotic, no ulceration is good. Looks like it was caught early. Best of Luck…
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- January 19, 2017 at 8:20 pm
Believe me Selle7, I am no expert on this. Because my daughter Julie has has been diagnosed with Stage 3, I am new here, but have found this forum to be so supportive. I am sure others will respond, who I know will have more insight then me. In any case, from what I see, I believe the report is saying most likely that this is a new primary and not a recurrent. the fact. that it is .8mm, no mitotic, no ulceration is good. Looks like it was caught early. Best of Luck…
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- January 19, 2017 at 8:20 pm
Believe me Selle7, I am no expert on this. Because my daughter Julie has has been diagnosed with Stage 3, I am new here, but have found this forum to be so supportive. I am sure others will respond, who I know will have more insight then me. In any case, from what I see, I believe the report is saying most likely that this is a new primary and not a recurrent. the fact. that it is .8mm, no mitotic, no ulceration is good. Looks like it was caught early. Best of Luck…
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- January 19, 2017 at 9:47 pm
It would be more helpful if you posted the entire report where we can get the full picture. Is that the final clinical diagnosis or is that the diagnosis the dermatologist submitted? Often times, the dermatologist will give an "impression" on his diagnosis so the pathologist wil have a starting point. That fits with the 1st line. Second line doesn't quite work like that. So this is where having the report in context would help.
Typically if they list a depth, it is considered a new primary. Unless it is located right next to a previous primary and could have been cells in the margins of the previous primary that were missed – hence recurrent or intransit options.
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- January 19, 2017 at 9:47 pm
It would be more helpful if you posted the entire report where we can get the full picture. Is that the final clinical diagnosis or is that the diagnosis the dermatologist submitted? Often times, the dermatologist will give an "impression" on his diagnosis so the pathologist wil have a starting point. That fits with the 1st line. Second line doesn't quite work like that. So this is where having the report in context would help.
Typically if they list a depth, it is considered a new primary. Unless it is located right next to a previous primary and could have been cells in the margins of the previous primary that were missed – hence recurrent or intransit options.
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- January 19, 2017 at 9:47 pm
It would be more helpful if you posted the entire report where we can get the full picture. Is that the final clinical diagnosis or is that the diagnosis the dermatologist submitted? Often times, the dermatologist will give an "impression" on his diagnosis so the pathologist wil have a starting point. That fits with the 1st line. Second line doesn't quite work like that. So this is where having the report in context would help.
Typically if they list a depth, it is considered a new primary. Unless it is located right next to a previous primary and could have been cells in the margins of the previous primary that were missed – hence recurrent or intransit options.
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- January 19, 2017 at 10:32 pm
Diagnoses:
Dermal focus of malignant melanoma
Tumour Thickness: 0.8mm
No Ulceration
Mitosis: None Identified
Cell Type: Large Epitheloid
Compltely Excised in the plane of sections examined
Please see comment
Diagnoses Comment:
Note is made of patients previous history of melanoma in the left neck/shoulder (thickness 1.9mm) with associated involvement of one sentinel node and negative completion lymphadenectomy. The current biopsy shows a small focus of malignant melanoma within the superficial dermis, abutting the dermal-epidermal junction. There is focal epidermotropism noted. The differential diagnosis includes a new primary lesion of modular melanoma versus focus of recurrent or in transit metastatic disease. Correlation with the biopsy site and relationship to previous excision may be helpful
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- January 19, 2017 at 10:32 pm
Diagnoses:
Dermal focus of malignant melanoma
Tumour Thickness: 0.8mm
No Ulceration
Mitosis: None Identified
Cell Type: Large Epitheloid
Compltely Excised in the plane of sections examined
Please see comment
Diagnoses Comment:
Note is made of patients previous history of melanoma in the left neck/shoulder (thickness 1.9mm) with associated involvement of one sentinel node and negative completion lymphadenectomy. The current biopsy shows a small focus of malignant melanoma within the superficial dermis, abutting the dermal-epidermal junction. There is focal epidermotropism noted. The differential diagnosis includes a new primary lesion of modular melanoma versus focus of recurrent or in transit metastatic disease. Correlation with the biopsy site and relationship to previous excision may be helpful
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- January 19, 2017 at 10:32 pm
Diagnoses:
Dermal focus of malignant melanoma
Tumour Thickness: 0.8mm
No Ulceration
Mitosis: None Identified
Cell Type: Large Epitheloid
Compltely Excised in the plane of sections examined
Please see comment
Diagnoses Comment:
Note is made of patients previous history of melanoma in the left neck/shoulder (thickness 1.9mm) with associated involvement of one sentinel node and negative completion lymphadenectomy. The current biopsy shows a small focus of malignant melanoma within the superficial dermis, abutting the dermal-epidermal junction. There is focal epidermotropism noted. The differential diagnosis includes a new primary lesion of modular melanoma versus focus of recurrent or in transit metastatic disease. Correlation with the biopsy site and relationship to previous excision may be helpful
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 20, 2017 at 11:26 am
My interpretation is this: there is a melanoma, and it could be (in medical terms 'differential diagnosis) EITHER a new primary unrelated to the previously removed melanoma OR a recurrence or in-transit melanoma that is 'secondary' to the previously removed melanoma. The former is the preferred option. A new primary is bad, but not as bad as a recurrence or in transit metastases. Unfortunately, given that this melanoma is in the dermis (and not epidermal), and given it's proximity to the scar site, it could well be the latter. This is a fairly uneducated guess by the way, but that's how I read it. Differential diagnosis means it could be this, or it could be that. For example, a headache could be dehydration, or it could be trauma from a hit to the head. Either/or.
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- January 23, 2017 at 2:15 am
The melanoma is found at the epidermal/dermal junction but not in the epidermis. This implies two things. Not in the epidermis so not 100% a new primary since primaries typically grow from the epidermis downward. But not in the deep dermis so not 100% in-transit or recurrent since in-transits tend to grow from the lymph vessels upwards to the dermis. So the pathologist is saying he can't make the determination based on the biopsy site alone because the proximity of the previous lesion is close. It needs correlation with where the previous excision was done and it may never be known for certain whether this is a primary or recurrence. I'm not a medical person but this is my best interpretation of what I see.
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- January 23, 2017 at 2:15 am
The melanoma is found at the epidermal/dermal junction but not in the epidermis. This implies two things. Not in the epidermis so not 100% a new primary since primaries typically grow from the epidermis downward. But not in the deep dermis so not 100% in-transit or recurrent since in-transits tend to grow from the lymph vessels upwards to the dermis. So the pathologist is saying he can't make the determination based on the biopsy site alone because the proximity of the previous lesion is close. It needs correlation with where the previous excision was done and it may never be known for certain whether this is a primary or recurrence. I'm not a medical person but this is my best interpretation of what I see.
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- January 23, 2017 at 2:15 am
The melanoma is found at the epidermal/dermal junction but not in the epidermis. This implies two things. Not in the epidermis so not 100% a new primary since primaries typically grow from the epidermis downward. But not in the deep dermis so not 100% in-transit or recurrent since in-transits tend to grow from the lymph vessels upwards to the dermis. So the pathologist is saying he can't make the determination based on the biopsy site alone because the proximity of the previous lesion is close. It needs correlation with where the previous excision was done and it may never be known for certain whether this is a primary or recurrence. I'm not a medical person but this is my best interpretation of what I see.
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Tagged: cutaneous melanoma
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