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First pathology Report says Melanoma Insitu and second review says no Melanoma just Atypia

Forums General Melanoma Community First pathology Report says Melanoma Insitu and second review says no Melanoma just Atypia

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    smatlock41
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    smatlock41's picture
    5/1/2011
    8:

    Posted By
    smatlock41's picture
    5/1/2011
    8:41am
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    I had a place taken off my cheek a month ago  by a shave biopsy and 2 weeks later the biopsy results came back and then said it was Melanoma Insitu Clark Level 1 which said it was superficial and only on the outer layer of the epidermis.  I went and picked up my report and after looking at it was confused because it had the doctors name that reviewed it (dermapathologist) but my doctor had signed for him and they also mentioned on the report that I had a history of melanoma.  Why would they need to state that on the pathology report?  The first review from him stated Atypia and then the final review was melanoma Insitu.  Anyways, I requested my slides from the dermatologist office and picked them up before my appointment with the plastic surgeon at Vanderbilt this past Thursday.  After looking at my report he also thought it looked a little strange.  I told him that I had my slides and would like someone at Vanderbilt to review them and he said oh good so he sent them down while I was there.  He went over 2 options to take care of this which were…..if he did the excision he would take .5cm all the way around.  He also told me about Moh's which he said may be the better option for me since they check the tissue as they go and can make a smaller scar.  I told him that would probably be the option that I would go with.  On Friday I get a call from the Moh's people at Vanderbilt that he had referred me to saying they had received my pathology report and no where on there did it state I had melanoma just Atypia.  She said they were going to send the report back to the plastic surgeon that I saw on Thurday.  She said you may not have to have anything done.  I said well since he did a shave he left me with a hole in my skin which I would like to have corrected.  They told me that it would fill in but I don't think so.  We are going on 5 weeks and it hasn't yet. So now I'm waiting on the plastic surgeons office to call me tomorrow to let me know what they think.  My question is if he goes back in to fix this hole and pull the skin together so I have a line that would look much better couldn't he test a little bit of tissue again to make sure it comes back ok?  Has anyone every experienced this?  I'm just so confused and stressed out and don't know what to do.  I don't want to be left with a bigger scar if its not necessary.  Any replies would be greatly appreciated.  Thanks! 

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      MichaelFL
      Participant

      Do you have your report? Post it here and someone can help you with it.

      If it is a severly atypical mole or melanoma in-situ, this needs to be discussed with the doctor before deciding what to do next, but it would seem MOHS would be the better option due to the location.

      Let the board know what is discussed with the doctors.

      Good luck,

       

      Michael

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      MichaelFL
      Participant

      Do you have your report? Post it here and someone can help you with it.

      If it is a severly atypical mole or melanoma in-situ, this needs to be discussed with the doctor before deciding what to do next, but it would seem MOHS would be the better option due to the location.

      Let the board know what is discussed with the doctors.

      Good luck,

       

      Michael

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        smatlock41
        Participant

        Thank you so much for your reply.  The sample that was taken was .5cm X .5cm and on the first pathology report it said "poorly circumscribed asymmetrical poliferation of melanocytes with severe cytologic atypia arranged in irregular nests and as single cells at the basal layer of the epidermis.  Atypical melanocytes are identified at higher levels of the epidermis.  The poliferation does not appear to extend into the underlying dermis.  Anti-S100, -HMB45, -MART1, and -MiTF atibodies all label the atypical melanocytes." 

        I will have to wait until tomorrow before I can see exactly what the second report says. 

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        smatlock41
        Participant

        Thank you so much for your reply.  The sample that was taken was .5cm X .5cm and on the first pathology report it said "poorly circumscribed asymmetrical poliferation of melanocytes with severe cytologic atypia arranged in irregular nests and as single cells at the basal layer of the epidermis.  Atypical melanocytes are identified at higher levels of the epidermis.  The poliferation does not appear to extend into the underlying dermis.  Anti-S100, -HMB45, -MART1, and -MiTF atibodies all label the atypical melanocytes." 

        I will have to wait until tomorrow before I can see exactly what the second report says. 

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        MichaelFL
        Participant

        Based on what you have posted from this firstreport, this is what is called a severely atypical mole or dysplastic nevus. (they are the same thing) This is not yet melanoma.

        They are graded as mild, moderate, and severe, and due to looking at the cells under a microscope, yours is severely atypical, but has not yet become melanoma. Most derms watch mildly atypical, will consider further excision for moderate, and pretty much always re-excise severely atypical moles.

        Let the board know what your other report says when you get it.

        Michael

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        MichaelFL
        Participant

        Based on what you have posted from this firstreport, this is what is called a severely atypical mole or dysplastic nevus. (they are the same thing) This is not yet melanoma.

        They are graded as mild, moderate, and severe, and due to looking at the cells under a microscope, yours is severely atypical, but has not yet become melanoma. Most derms watch mildly atypical, will consider further excision for moderate, and pretty much always re-excise severely atypical moles.

        Let the board know what your other report says when you get it.

        Michael

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        MichaelFL
        Participant

        Whoever did the other report probably went with melanoma in-situ to cover themselves.

        Michael

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        MichaelFL
        Participant

        Whoever did the other report probably went with melanoma in-situ to cover themselves.

        Michael

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        smatlock41
        Participant

        I can't help but wonder if that is the case as well.  I will post tomorrow after I find out what the 2nd report says.  Thank you so much for you replies I really appreciate it.

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        smatlock41
        Participant

        I can't help but wonder if that is the case as well.  I will post tomorrow after I find out what the 2nd report says.  Thank you so much for you replies I really appreciate it.

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        smatlock41
        Participant

        The second report says "junctional nevus with marked architectural and cytologic atypia, shave margins appear to be free of the junctional melanocytic proliferation.  Looks like 3 pathologists checked this out before they signed off on this report.  Still waiting on the doctor to call to see what needs to be done.  I'm assuming they will want to go in and do an excision but I'm wondering how much they will take.  The spot is only about 1/4 inch now.  I guess we will see.  

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        Janner
        Participant

        Marked atypia.  Not sure if they consider that moderate or severe so you'll have to get clarification from your derm.  The good news is the margins appear to be clear already.  So it might only need a small excision.  As far as a new scar goes, it will take 3x the width to close the wound.  So if they take 3mm margins, the length of the wound would be close to 9mm.  This can vary based on the anatomy, however, and how tight the skin is already in the area.

        I'm glad this isn't melanoma!  Keep a watch out for future changing moles!

        Best wishes,

        Janner

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        Janner
        Participant

        Marked atypia.  Not sure if they consider that moderate or severe so you'll have to get clarification from your derm.  The good news is the margins appear to be clear already.  So it might only need a small excision.  As far as a new scar goes, it will take 3x the width to close the wound.  So if they take 3mm margins, the length of the wound would be close to 9mm.  This can vary based on the anatomy, however, and how tight the skin is already in the area.

        I'm glad this isn't melanoma!  Keep a watch out for future changing moles!

        Best wishes,

        Janner

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        MichaelFL
        Participant

        This is also a atypical mole or dysplastic nevus report. So where did the in-situ pathology report come from?

        Michael

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        smatlock41
        Participant

        My dermatologist office.  That was my first appointment there and I wasn't impressed with the doctor at all.  On the first pathology report the first diagnosis was r/o atypia, and the final diagnosis after stainings etc. was melanoma insitu. On the report it had a doctors name Robert Chen but was signed by my dermatologist which I thought was strange.   I decided to go to a doctor at Vanderbilt and that is when I decided to pick up my slides from my dermatologists office and take them there for a second review. 

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        MichaelFL
        Participant

        Ok, now I understand the full picture.

        After you discuss having either a WLE or possibly MOHS, let the board know what the doc says, and what you decide to do.

        Michael

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        smatlock41
        Participant
        I’m scheduled to have a small excision done by a plastic surgeon on the 27th to make sure everything is clear.

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        smatlock41
        Participant
        I’m scheduled to have a small excision done by a plastic surgeon on the 27th to make sure everything is clear.

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        MichaelFL
        Participant

        Glad to hear you have everything well in hand.

        Michael

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        MichaelFL
        Participant

        Glad to hear you have everything well in hand.

        Michael

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        MichaelFL
        Participant

        Ok, now I understand the full picture.

        After you discuss having either a WLE or possibly MOHS, let the board know what the doc says, and what you decide to do.

        Michael

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        smatlock41
        Participant

        My dermatologist office.  That was my first appointment there and I wasn't impressed with the doctor at all.  On the first pathology report the first diagnosis was r/o atypia, and the final diagnosis after stainings etc. was melanoma insitu. On the report it had a doctors name Robert Chen but was signed by my dermatologist which I thought was strange.   I decided to go to a doctor at Vanderbilt and that is when I decided to pick up my slides from my dermatologists office and take them there for a second review. 

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        MichaelFL
        Participant

        This is also a atypical mole or dysplastic nevus report. So where did the in-situ pathology report come from?

        Michael

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        smatlock41
        Participant

        The second report says "junctional nevus with marked architectural and cytologic atypia, shave margins appear to be free of the junctional melanocytic proliferation.  Looks like 3 pathologists checked this out before they signed off on this report.  Still waiting on the doctor to call to see what needs to be done.  I'm assuming they will want to go in and do an excision but I'm wondering how much they will take.  The spot is only about 1/4 inch now.  I guess we will see.  

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