Help Reading a Melanoma Surgery Removal Report

The report is a little hard to read because of the loss of carriage returns.  But what I'm reading is a 4cm nodule with a high mitotic rate.  0 is ideal, 16 is considered high.  This means the tumor cells are dividing rapidly.  Because of the polypoid diagnosis, depth might be interpreted a little differently.  That's a more unusual diagnosis.  My comments come more from a background of reading reports of a tumor that is not above but in/under the skin.

For any stage 2 lesion, the excision should remove at least 2cm all around the lesion.  It appears he has 1.8cm on the peripheral margin but only 1cm from the deep margin.  It is good the deep margin is not involved, but again a larger clear margin might be desired.  This may or may not be possible.  They most likely removed all the tissue down to the muscle fasia layer.  I know some docs who have removed muscle tissue as well to get additional margins – but as you haven't given us any additional info, that's about as much as I can comment on.

Ulceration – under a microscope, the epidermis has been compromised.  This tends to carry a worse prognosis than lesions that are not ulcerated and typically raises staging by one level.

Microsatellitosis – no satellite lesions were identified.  No obvious cells starting new colonies nearby.

Lymph-Vascular invasion – they can't make a definite diagnosis from the tissue samples they have.  This is obvious tumor infiltration of a lymph or blood vessel.  This isn't anything to do with if the lymph nodes are involved.

Perineural invasion – melanoma not seen involving nerves.

Tumor Infiltration Lymphocytes – not identified.  This can be a good or bad factor depending upon what you read.  Basically, the body really hasn't identified the lesion as bad and hasn't sent any armies to try and destroy it.

Tumor regression – not identified.  This goes along with the above item – the body has not tried to do anything to kill the tumor.  Regression can also be a mixed bag, but in this case – the body's immune system is doing nothing to try and eradicate this tumor, it isn't recognizing it as bad.

Typically, disecting a pathology report line by line isn't all that productive.  The final diagnosis really is the most important part.  All of the details listed just support the final diagnosis and stage.

Has he had some type of sentinel lymph node biopsy?  Are they or have they checked the lymph nodes for melanoma involvement?  Has he had any other type of scans?

Ideally, they would have done the sentinel lymph node biopsy PRIOR to the wide excision.  The sentinel lymph node biopsy may not be of much use now because the large surgical removal may have changed the lymph node drainage patterns.  If he has palpable lymph nodes on the same side, that is worrisome.  It doesn't sound like he is being seen by a melanoma specialist.  I strongly recommend that if at all possible.  You can post and ask for suggestions in your area here.  This is a very worrisome diagnosis and he really needs to see someone who specializes in melanoma for the best treatment options.  A derm or general oncologist just aren't the right ones in this situation.  THIS IS VERY IMPORTANT!

Can you do a phone consult with Moffit?  They are a well known melanoma center.  Dr. Weber is well renowned and would likely do a consult.

Scans can't show microscopic disease.  Tumors have to be a certain size to show up, hence the SNB where they inspect the tissue microscopically.

I think you want scans to see if there is evidence of this elsewhere.  If scans are clean, then you decide about removing all the lymph nodes in the basin.  If the scans show the disease is already systemic, no need for the node removal until all options for treatment have been discussed.  

Can you do a phone consult with Moffit?  They are a well known melanoma center.  Dr. Weber is well renowned and would likely do a consult.

Scans can't show microscopic disease.  Tumors have to be a certain size to show up, hence the SNB where they inspect the tissue microscopically.

I think you want scans to see if there is evidence of this elsewhere.  If scans are clean, then you decide about removing all the lymph nodes in the basin.  If the scans show the disease is already systemic, no need for the node removal until all options for treatment have been discussed.  

Can you do a phone consult with Moffit?  They are a well known melanoma center.  Dr. Weber is well renowned and would likely do a consult.

Scans can't show microscopic disease.  Tumors have to be a certain size to show up, hence the SNB where they inspect the tissue microscopically.

I think you want scans to see if there is evidence of this elsewhere.  If scans are clean, then you decide about removing all the lymph nodes in the basin.  If the scans show the disease is already systemic, no need for the node removal until all options for treatment have been discussed.  

Ideally, they would have done the sentinel lymph node biopsy PRIOR to the wide excision.  The sentinel lymph node biopsy may not be of much use now because the large surgical removal may have changed the lymph node drainage patterns.  If he has palpable lymph nodes on the same side, that is worrisome.  It doesn't sound like he is being seen by a melanoma specialist.  I strongly recommend that if at all possible.  You can post and ask for suggestions in your area here.  This is a very worrisome diagnosis and he really needs to see someone who specializes in melanoma for the best treatment options.  A derm or general oncologist just aren't the right ones in this situation.  THIS IS VERY IMPORTANT!

Ideally, they would have done the sentinel lymph node biopsy PRIOR to the wide excision.  The sentinel lymph node biopsy may not be of much use now because the large surgical removal may have changed the lymph node drainage patterns.  If he has palpable lymph nodes on the same side, that is worrisome.  It doesn't sound like he is being seen by a melanoma specialist.  I strongly recommend that if at all possible.  You can post and ask for suggestions in your area here.  This is a very worrisome diagnosis and he really needs to see someone who specializes in melanoma for the best treatment options.  A derm or general oncologist just aren't the right ones in this situation.  THIS IS VERY IMPORTANT!

The report is a little hard to read because of the loss of carriage returns.  But what I'm reading is a 4cm nodule with a high mitotic rate.  0 is ideal, 16 is considered high.  This means the tumor cells are dividing rapidly.  Because of the polypoid diagnosis, depth might be interpreted a little differently.  That's a more unusual diagnosis.  My comments come more from a background of reading reports of a tumor that is not above but in/under the skin.

For any stage 2 lesion, the excision should remove at least 2cm all around the lesion.  It appears he has 1.8cm on the peripheral margin but only 1cm from the deep margin.  It is good the deep margin is not involved, but again a larger clear margin might be desired.  This may or may not be possible.  They most likely removed all the tissue down to the muscle fasia layer.  I know some docs who have removed muscle tissue as well to get additional margins – but as you haven't given us any additional info, that's about as much as I can comment on.

Ulceration – under a microscope, the epidermis has been compromised.  This tends to carry a worse prognosis than lesions that are not ulcerated and typically raises staging by one level.

Microsatellitosis – no satellite lesions were identified.  No obvious cells starting new colonies nearby.

Lymph-Vascular invasion – they can't make a definite diagnosis from the tissue samples they have.  This is obvious tumor infiltration of a lymph or blood vessel.  This isn't anything to do with if the lymph nodes are involved.

Perineural invasion – melanoma not seen involving nerves.

Tumor Infiltration Lymphocytes – not identified.  This can be a good or bad factor depending upon what you read.  Basically, the body really hasn't identified the lesion as bad and hasn't sent any armies to try and destroy it.

Tumor regression – not identified.  This goes along with the above item – the body has not tried to do anything to kill the tumor.  Regression can also be a mixed bag, but in this case – the body's immune system is doing nothing to try and eradicate this tumor, it isn't recognizing it as bad.

Typically, disecting a pathology report line by line isn't all that productive.  The final diagnosis really is the most important part.  All of the details listed just support the final diagnosis and stage.

Has he had some type of sentinel lymph node biopsy?  Are they or have they checked the lymph nodes for melanoma involvement?  Has he had any other type of scans?

The report is a little hard to read because of the loss of carriage returns.  But what I'm reading is a 4cm nodule with a high mitotic rate.  0 is ideal, 16 is considered high.  This means the tumor cells are dividing rapidly.  Because of the polypoid diagnosis, depth might be interpreted a little differently.  That's a more unusual diagnosis.  My comments come more from a background of reading reports of a tumor that is not above but in/under the skin.

For any stage 2 lesion, the excision should remove at least 2cm all around the lesion.  It appears he has 1.8cm on the peripheral margin but only 1cm from the deep margin.  It is good the deep margin is not involved, but again a larger clear margin might be desired.  This may or may not be possible.  They most likely removed all the tissue down to the muscle fasia layer.  I know some docs who have removed muscle tissue as well to get additional margins – but as you haven't given us any additional info, that's about as much as I can comment on.

Ulceration – under a microscope, the epidermis has been compromised.  This tends to carry a worse prognosis than lesions that are not ulcerated and typically raises staging by one level.

Microsatellitosis – no satellite lesions were identified.  No obvious cells starting new colonies nearby.

Lymph-Vascular invasion – they can't make a definite diagnosis from the tissue samples they have.  This is obvious tumor infiltration of a lymph or blood vessel.  This isn't anything to do with if the lymph nodes are involved.

Perineural invasion – melanoma not seen involving nerves.

Tumor Infiltration Lymphocytes – not identified.  This can be a good or bad factor depending upon what you read.  Basically, the body really hasn't identified the lesion as bad and hasn't sent any armies to try and destroy it.

Tumor regression – not identified.  This goes along with the above item – the body has not tried to do anything to kill the tumor.  Regression can also be a mixed bag, but in this case – the body's immune system is doing nothing to try and eradicate this tumor, it isn't recognizing it as bad.

Typically, disecting a pathology report line by line isn't all that productive.  The final diagnosis really is the most important part.  All of the details listed just support the final diagnosis and stage.

Has he had some type of sentinel lymph node biopsy?  Are they or have they checked the lymph nodes for melanoma involvement?  Has he had any other type of scans?