further advice please

Hi there,

Hi there,

I am asking for advise yet again on the melanoma in situ that I had removed from my upper left arm. A  brief recap…. the intial mole was excised by the dermatologist on 5/17/10. It was diagnosed as melanoma in situ. I saw a plastic surgeon on 6/7/10 and had another, somewhat larger excision and the pathology report recommended a further excsion as "In block 3, the residual proliferation of atypical melanocytes is virtually transected at a lateral margin". The plastic surgeon said I didn't need a further excision, that it was just my 'skin type' (freckled and fair) and sun damage that was showing up and that atypical melanocytes would appear probably anywhere on my skin. I decided, against his advise, to have a further excision which was performed on 7/28/10. The plastic surgeon told me over the phone that further atypical melanocytes had been found "as he expected", and that he would suggest leaving it at this point and just watching closely. He did tell me, however, that he had spoken to the pathologist, "with whom he shared great concern about me" and that the pathologist had suggested that a further biospy might be done on the same arm in the same area, but a couple of inches away from the original site, to make some comparisons. The idea is that if further atypical melanocytes are found, we might assume that it is truly a reflection of long-term sun damage and not limited to that particular area. He assured me that the original lesion has been completely removed. He also told me that melanoma in situ is a complete diagnosis, that it couldn't be described as a particular type of melanoma at this stage. That contradicts what I have read here and on other sites. I posted all of this the other day and got some repsonses which were helpful, but I received the pathology report today in the mail and it sounds a little more alarming. You will find it below.

I am asking for some help deciphering it and suggestions as to what I should do next. I am thinking of getting a second opinion and also wondered if anyone knew of a melanoma specialist in the Central New York area. I am also willing to travel. Both NYC and Boston are about 4-5 hours away.

Forgive me, but I am going to type out the entire patho report! Here goes….

"MICROSCPIC DESCRIPTION:

Histologic  sections on a fusiform excision of skin with adipose tissue at the base show epidermis with solar elastosis and mixed chronic stromal inflammation and a dermal proliferation of nevoid melanocytes within the superficial dermis transected at an edge. There is overlying irregular junctional melanocytic hyperplasia. Centrally, there is stromal fibroplasia and mixed chronic inflammation, compatible with scar transected along an edge. There is adjacent irregular melanocytic proliferation with rare pagetoid melanocytes within deeper levels.

IMPRESSION:

ATYPICAL JUNCTIONAL MELANOCYTIC HYPERPLASIA AND SCAR WITH WOUND REPAIR REACTION (SEE COMMENT).

COMMENT: The scar and the melanocytic hyperplasia are transected along an edge. There is a dermal proliferation of nevoid melanocytes which does not appear related to the overlying junctional melanocytic proliferation. Although these findings may represent the background changes associated with chronic actinic damage, the extent of disarray and atypia is very concerning. Comparison with adjacent similarly sun-exposed skin, not involving the excisional site, may be of diagnostic utility in further evaluation. Thsi specimen was reviewed in conjunction with case #……. This case was seen in consultation with Drs T Chang, J Bass and C Jaworsky"

It then attaches the previous reports from the previous excisions. It was signed by Dr H Winfield.

Thanks very much. It is all a bot scary. i know most of you have got much worse stuff going on and I appreciate your time and support.

Jennifer