› Forums › Cutaneous Melanoma Community › False positive pathological report, any chance?
- This topic has 15 replies, 7 voices, and was last updated 5 years, 5 months ago by desertdweller.
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- July 10, 2013 at 4:07 am
Hi,
I am an Asian male, 34, and have had a mole-like lesion on my right arm since I was very young (or even likely born with it) for as long as I can remember, and more importantly, its size and shape has NOT changed at all since at least 15 years ago when my parents and I I started observing it.
Hi,
I am an Asian male, 34, and have had a mole-like lesion on my right arm since I was very young (or even likely born with it) for as long as I can remember, and more importantly, its size and shape has NOT changed at all since at least 15 years ago when my parents and I I started observing it.
In late June, I went to see a dermatologist for a separate condition (a mole on my face), which the doctor very quickly dismissed as anything alarming but believed that the congenital nevus on my arm closely resembles the typical melanoma: blurry boarders, asymmetric shape, etc. The only counter-argument I had was that it has NOT changed at all for at least 15 years. The doctor then advised that a PREVENTATIVE full excision be performed, even it was NOT likely a melanoma due to my race, age, which I followed and the full excision biopsy was performed.
2 weeks later (just today), the pathologist's report came back with a shocking melanoma diagnosis:
'right posterior arm, malignant melanoma, approx. 0.4mm tumor thickness with associated congenital compound nevus, 0 mitotic figures per mm2, nonulcerated, completely excised on all edges and in depth.
comment: ki-67 would be of value to better interpret the dermal cells which, although they resemble the epidermal cells, merge into areas of congenital nevus with areas of maturation.'
In 'layman's language', the doctor told me:
1) according to the 1st pathological reading of the biopsy sample, this is a malignant melanoma
2) based on info presented, it looks like a Stage I, but we have ordered staining (ki-67 is actually a protein)/enhanced specimen processing ('2nd pathological reading') to see if my melanoma cells are REALLY contained within the 0.4mm depth vs. having already spread
3) regardless of the 2nd pathological reading, a 2nd excision surgery needs to be performed ASAP to remove an even larger area, but the 2nd pathological reading will determine how deep/wide this 2nd excision will be.
My questions at this stage is simple – could the 1st pathological reading have been 'a false positive', considering the fact that my lesion has NOT changed for at least 15 years (not months!)? I read somewhere that about 16% melanoma biopsies result in false positives, however they usually occur during partial excision (my case was full excision). Also to my 'disadvantage', both my dermatologist and his dermatological pathologist agreed with the melanoma diagnosis.
Any opinion or references will be helpful. I have a loving and supporting yet vulnerable wife, a 3 year old girl, and a 25 day old son. Your prayers will be greatly appreciated.
Thanks
Joe
- Replies
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- July 10, 2013 at 4:27 am
Could it be a false positive. Possibly, but not too likely. In any event, you should treat it as melanoma "just in case". I'm not sure about waiting for the staining to determine how wide the 2nd excision should be. Anything < 2mm is excised with 1cm margins and always down to the muscle fascia. It seems unlikely that the 2nd pathology would jump from 0.4mm to > 2mm so the margins should be 1cm. As for ASAP, mentally that's good, but medically it doesn't seem to affect prognosis if the excision is delayed.
Congenital nevi are kind of their own beast. It's possible that this has been in this same state for many years. It could have been very atypical/cancerous from early on and then just stopped in the state it is in now. There is no way to know for sure, but congenital nevi do carry a higher risk for becoming melanoma. A mitosis of 0 basically says it wasn't going anywhere fast.
I also think that some of the false positives would be those that are "in situ". They say that in situ is often over diagnosed now — pathologists erring on the side of caution. So a lesion that is borderline in situ versus severely atypical might be diagnosed "in situ" to protect the pathologist against misdiagnosis.
The bottom line is that a stage IA lesion still has a fantastic prognosis as far as cancer goes. So while it would be nice to think this is a false positive, it shouldn't be treated as such — either by you or the doctors.
Sorry you had to join the melanoma club.
Janner
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- October 24, 2018 at 7:36 am
I know this is an old post, but has anyone got any actual scientific evidence that digging into an old, congenital mole, and finding evidence of essentially 0-stage melanoma results in improved survivability, or even statistical survivability that is equivalent to not disturbing it in the first place?
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- October 25, 2018 at 7:04 am
I know this is an old post, but has anyone got any actual scientific evidence that the practice of digging into an old, stable,congenital mole, and finding evidence of essentially 0-stage melanoma results in improved survivability, or even statistical survivability that is as good as simply not disturbing it in the first place?
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- July 10, 2013 at 4:27 am
Could it be a false positive. Possibly, but not too likely. In any event, you should treat it as melanoma "just in case". I'm not sure about waiting for the staining to determine how wide the 2nd excision should be. Anything < 2mm is excised with 1cm margins and always down to the muscle fascia. It seems unlikely that the 2nd pathology would jump from 0.4mm to > 2mm so the margins should be 1cm. As for ASAP, mentally that's good, but medically it doesn't seem to affect prognosis if the excision is delayed.
Congenital nevi are kind of their own beast. It's possible that this has been in this same state for many years. It could have been very atypical/cancerous from early on and then just stopped in the state it is in now. There is no way to know for sure, but congenital nevi do carry a higher risk for becoming melanoma. A mitosis of 0 basically says it wasn't going anywhere fast.
I also think that some of the false positives would be those that are "in situ". They say that in situ is often over diagnosed now — pathologists erring on the side of caution. So a lesion that is borderline in situ versus severely atypical might be diagnosed "in situ" to protect the pathologist against misdiagnosis.
The bottom line is that a stage IA lesion still has a fantastic prognosis as far as cancer goes. So while it would be nice to think this is a false positive, it shouldn't be treated as such — either by you or the doctors.
Sorry you had to join the melanoma club.
Janner
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- July 10, 2013 at 4:27 am
Could it be a false positive. Possibly, but not too likely. In any event, you should treat it as melanoma "just in case". I'm not sure about waiting for the staining to determine how wide the 2nd excision should be. Anything < 2mm is excised with 1cm margins and always down to the muscle fascia. It seems unlikely that the 2nd pathology would jump from 0.4mm to > 2mm so the margins should be 1cm. As for ASAP, mentally that's good, but medically it doesn't seem to affect prognosis if the excision is delayed.
Congenital nevi are kind of their own beast. It's possible that this has been in this same state for many years. It could have been very atypical/cancerous from early on and then just stopped in the state it is in now. There is no way to know for sure, but congenital nevi do carry a higher risk for becoming melanoma. A mitosis of 0 basically says it wasn't going anywhere fast.
I also think that some of the false positives would be those that are "in situ". They say that in situ is often over diagnosed now — pathologists erring on the side of caution. So a lesion that is borderline in situ versus severely atypical might be diagnosed "in situ" to protect the pathologist against misdiagnosis.
The bottom line is that a stage IA lesion still has a fantastic prognosis as far as cancer goes. So while it would be nice to think this is a false positive, it shouldn't be treated as such — either by you or the doctors.
Sorry you had to join the melanoma club.
Janner
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- July 10, 2013 at 12:02 pm
My brother had red hair, fair skin, lots of freckles, and spent a lot of time in the sun. He had a lesion on his leg that had been there for years and years (perhaps all his life, I don't know). Several times over the course of 2 or 3 years his dermatologist wanted to biopsy it but my brother always refused because "it's always been there" and "it hasn't changed". The dermatologist was very frustrated, but she had to respect the patient's wishes.
Finally, the lesion did get larger (she had a photographic record) and my brother allowed her to biopsy it. It was melanoma. Unfortunately, by then the melanoma had spread throughout his body including the brain and he was dead 18 months later. To this day, I keep asking myself, "Why oh why didn't my brother just let the doctor biopsy it the first time she expressed concern?! What the heck was the matter with him?!"
Luckily for you, your lesion was very thin and very slow growing. With close follow-up you will probably be fine. But rather than continuing to hope and pray that this current lesion is NOT melanoma, it would be better for you to have the attitude, "Thank God they got it in time!". And in the future, if you or any dermatologist thinks a lesion should be removed because it "looks kind of funny", just DO it. OK?
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- April 24, 2015 at 4:13 pm
Hi! I know this is an older post but I am going through the same thing! Wondering how it all turned out? My diagnosis (after have 2 reports done one saying insitu and one say .55mm) But my nevus is going down to 1.5mm. They said excision is recommended and SNLB is something i should talk about but not 100% needed. Did you do this?
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- May 4, 2017 at 9:46 pm
Hi Joe and Jess Ann,
Did you ever have any follow up to this?
I was diagnosed with melanoma .3MM or .25MM on different pathology reports. I had it sent in for the castle DecisionDx testing.
The only thing that I've wondered is that I hadn't mentioned to the dermatologist that I had a bad sunburn 3 days before the biopsy. (I was on a boat with no shade over spring break) and twenty minutes before the biopsy, I ran 5 miles and the mole is directly under my sports bra line so it was probably quite irritated. The dermatologist took the biopsy because it was red. I should have said something at the time but I never thought it would come back positive.
Anyhow, the pathology report talks about a "paucity of cells in the dermis" and highly inflamed skin. Is there any chance this could be a false positive for melanoma since I didn't give the dr. all of the information?
Probably not… but a girl can hope.
Does anyone know – would the DecisionDx be able to confirm that it is definitely a melanoma?
Thank you,
Kate
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- April 24, 2015 at 4:13 pm
Hi! I know this is an older post but I am going through the same thing! Wondering how it all turned out? My diagnosis (after have 2 reports done one saying insitu and one say .55mm) But my nevus is going down to 1.5mm. They said excision is recommended and SNLB is something i should talk about but not 100% needed. Did you do this?
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- April 24, 2015 at 4:13 pm
Hi! I know this is an older post but I am going through the same thing! Wondering how it all turned out? My diagnosis (after have 2 reports done one saying insitu and one say .55mm) But my nevus is going down to 1.5mm. They said excision is recommended and SNLB is something i should talk about but not 100% needed. Did you do this?
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- July 10, 2013 at 12:02 pm
My brother had red hair, fair skin, lots of freckles, and spent a lot of time in the sun. He had a lesion on his leg that had been there for years and years (perhaps all his life, I don't know). Several times over the course of 2 or 3 years his dermatologist wanted to biopsy it but my brother always refused because "it's always been there" and "it hasn't changed". The dermatologist was very frustrated, but she had to respect the patient's wishes.
Finally, the lesion did get larger (she had a photographic record) and my brother allowed her to biopsy it. It was melanoma. Unfortunately, by then the melanoma had spread throughout his body including the brain and he was dead 18 months later. To this day, I keep asking myself, "Why oh why didn't my brother just let the doctor biopsy it the first time she expressed concern?! What the heck was the matter with him?!"
Luckily for you, your lesion was very thin and very slow growing. With close follow-up you will probably be fine. But rather than continuing to hope and pray that this current lesion is NOT melanoma, it would be better for you to have the attitude, "Thank God they got it in time!". And in the future, if you or any dermatologist thinks a lesion should be removed because it "looks kind of funny", just DO it. OK?
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- July 10, 2013 at 12:02 pm
My brother had red hair, fair skin, lots of freckles, and spent a lot of time in the sun. He had a lesion on his leg that had been there for years and years (perhaps all his life, I don't know). Several times over the course of 2 or 3 years his dermatologist wanted to biopsy it but my brother always refused because "it's always been there" and "it hasn't changed". The dermatologist was very frustrated, but she had to respect the patient's wishes.
Finally, the lesion did get larger (she had a photographic record) and my brother allowed her to biopsy it. It was melanoma. Unfortunately, by then the melanoma had spread throughout his body including the brain and he was dead 18 months later. To this day, I keep asking myself, "Why oh why didn't my brother just let the doctor biopsy it the first time she expressed concern?! What the heck was the matter with him?!"
Luckily for you, your lesion was very thin and very slow growing. With close follow-up you will probably be fine. But rather than continuing to hope and pray that this current lesion is NOT melanoma, it would be better for you to have the attitude, "Thank God they got it in time!". And in the future, if you or any dermatologist thinks a lesion should be removed because it "looks kind of funny", just DO it. OK?
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Tagged: cutaneous melanoma
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