Help with my Pathology report from Shave biopsy

Yes.  As I said above, the shave biopsy was very shallow and cut the lesion in half.  It only got part of the lesion and you don't know how deep it really is.  Depth is very important.  I'm not a big fan of shave biopsies for this very reason.  Derms like them because they are quick and don't require stitches or followups to remove stitches, but they can compromise staging information like I said above.

Clark's Level is subjective and no longer really used.  It just means the "level" of skin invaded, but there are no definite dividing lines between anything besides the epidermis and dermal junction.  Inside the dermis, the levels are subjective.  That is why Breslow depth is now considered the most important feature – it is much less subjective.  Clarks Level changes throughout the body — if the skin is really thin, the levels are thinner.  Think about skin near your eye versus skin on your heel.  They aren't the same thickness and the Clark's Level is different in both locations. 

The fact that your lesion hasn't shown obvious signs of change probably mean that this is something slow growing – and that is a good thing. Nodular melanoma is often very fast growing but other things in the report made me question that – hence wondering if this was slow or fast growing.  Intradermal nevus is just a mole that is deeper than the topmost layer of the skin.  Most moles are just found in the epidermis only.

Pathology is an art as much as a science.  You want slides read by a dermatopathologist (skin pathologist only) who sees a lot of melanoma.  MDA sees a lot of melanoma.  If you sent your slides elsewhere, it is possible the report might read a little differently.  But your lesion is not the same as many that are diagnosed – not run of the mill superficial spreading melanoma which accounts for about 70% of all melanomas.  Yours is a big different and that is probably why the difference between reports. 

Yes.  As I said above, the shave biopsy was very shallow and cut the lesion in half.  It only got part of the lesion and you don't know how deep it really is.  Depth is very important.  I'm not a big fan of shave biopsies for this very reason.  Derms like them because they are quick and don't require stitches or followups to remove stitches, but they can compromise staging information like I said above.

Clark's Level is subjective and no longer really used.  It just means the "level" of skin invaded, but there are no definite dividing lines between anything besides the epidermis and dermal junction.  Inside the dermis, the levels are subjective.  That is why Breslow depth is now considered the most important feature – it is much less subjective.  Clarks Level changes throughout the body — if the skin is really thin, the levels are thinner.  Think about skin near your eye versus skin on your heel.  They aren't the same thickness and the Clark's Level is different in both locations. 

The fact that your lesion hasn't shown obvious signs of change probably mean that this is something slow growing – and that is a good thing. Nodular melanoma is often very fast growing but other things in the report made me question that – hence wondering if this was slow or fast growing.  Intradermal nevus is just a mole that is deeper than the topmost layer of the skin.  Most moles are just found in the epidermis only.

Pathology is an art as much as a science.  You want slides read by a dermatopathologist (skin pathologist only) who sees a lot of melanoma.  MDA sees a lot of melanoma.  If you sent your slides elsewhere, it is possible the report might read a little differently.  But your lesion is not the same as many that are diagnosed – not run of the mill superficial spreading melanoma which accounts for about 70% of all melanomas.  Yours is a big different and that is probably why the difference between reports. 

Yes.  As I said above, the shave biopsy was very shallow and cut the lesion in half.  It only got part of the lesion and you don't know how deep it really is.  Depth is very important.  I'm not a big fan of shave biopsies for this very reason.  Derms like them because they are quick and don't require stitches or followups to remove stitches, but they can compromise staging information like I said above.

Clark's Level is subjective and no longer really used.  It just means the "level" of skin invaded, but there are no definite dividing lines between anything besides the epidermis and dermal junction.  Inside the dermis, the levels are subjective.  That is why Breslow depth is now considered the most important feature – it is much less subjective.  Clarks Level changes throughout the body — if the skin is really thin, the levels are thinner.  Think about skin near your eye versus skin on your heel.  They aren't the same thickness and the Clark's Level is different in both locations. 

The fact that your lesion hasn't shown obvious signs of change probably mean that this is something slow growing – and that is a good thing. Nodular melanoma is often very fast growing but other things in the report made me question that – hence wondering if this was slow or fast growing.  Intradermal nevus is just a mole that is deeper than the topmost layer of the skin.  Most moles are just found in the epidermis only.

Pathology is an art as much as a science.  You want slides read by a dermatopathologist (skin pathologist only) who sees a lot of melanoma.  MDA sees a lot of melanoma.  If you sent your slides elsewhere, it is possible the report might read a little differently.  But your lesion is not the same as many that are diagnosed – not run of the mill superficial spreading melanoma which accounts for about 70% of all melanomas.  Yours is a big different and that is probably why the difference between reports. 

Yes.  The SLNB is general anesthsia.  The WLE doesn't have to be but is typically done in the same setting as the SLNB if it is done.  Margins are based upon depth.  Anything under 2mm depth has 1cm margins.  Greater than 2mm depth has 2cm margins.  Typically same day surgery or maybe one night.  Recovery is fairly easy – you would have a small incision in your armpit area and a large incision where the melanoma is located.  While not fun, unless the melanoma is located on one of the joints, you will most likely experience tightness because a large chunk of skin is removed.  Just a warning, 1cm margins does not mean a 2cm scar.  It will be inches long.  In order to achieve 1cm margins from the center, that means you have to close a 2cm hole.  And to do that, you need to make an elliptical incision so you can ease the skin together.

If you do a search on this site, you will find tons of information on recovery.

Yes.  The SLNB is general anesthsia.  The WLE doesn't have to be but is typically done in the same setting as the SLNB if it is done.  Margins are based upon depth.  Anything under 2mm depth has 1cm margins.  Greater than 2mm depth has 2cm margins.  Typically same day surgery or maybe one night.  Recovery is fairly easy – you would have a small incision in your armpit area and a large incision where the melanoma is located.  While not fun, unless the melanoma is located on one of the joints, you will most likely experience tightness because a large chunk of skin is removed.  Just a warning, 1cm margins does not mean a 2cm scar.  It will be inches long.  In order to achieve 1cm margins from the center, that means you have to close a 2cm hole.  And to do that, you need to make an elliptical incision so you can ease the skin together.

If you do a search on this site, you will find tons of information on recovery.

Just to be safe, I would request that the other biopsies be sent to MDA as well.  When I was originally diagnosed with my melanoma, the cancer center I went to actually requested all of my dermatology specimens to reread just in case.  In fact, one of my mild atypias came back as moderate on the second review and they suggested additional margins on it as a precaution because of my new history.  What my cancer center told me is that out of the specimens they receive, 10% are overread, 10% are underread – so there is that anxiety to contend with as well!

Just to be safe, I would request that the other biopsies be sent to MDA as well.  When I was originally diagnosed with my melanoma, the cancer center I went to actually requested all of my dermatology specimens to reread just in case.  In fact, one of my mild atypias came back as moderate on the second review and they suggested additional margins on it as a precaution because of my new history.  What my cancer center told me is that out of the specimens they receive, 10% are overread, 10% are underread – so there is that anxiety to contend with as well!

Just to be safe, I would request that the other biopsies be sent to MDA as well.  When I was originally diagnosed with my melanoma, the cancer center I went to actually requested all of my dermatology specimens to reread just in case.  In fact, one of my mild atypias came back as moderate on the second review and they suggested additional margins on it as a precaution because of my new history.  What my cancer center told me is that out of the specimens they receive, 10% are overread, 10% are underread – so there is that anxiety to contend with as well!

Yes.  The SLNB is general anesthsia.  The WLE doesn't have to be but is typically done in the same setting as the SLNB if it is done.  Margins are based upon depth.  Anything under 2mm depth has 1cm margins.  Greater than 2mm depth has 2cm margins.  Typically same day surgery or maybe one night.  Recovery is fairly easy – you would have a small incision in your armpit area and a large incision where the melanoma is located.  While not fun, unless the melanoma is located on one of the joints, you will most likely experience tightness because a large chunk of skin is removed.  Just a warning, 1cm margins does not mean a 2cm scar.  It will be inches long.  In order to achieve 1cm margins from the center, that means you have to close a 2cm hole.  And to do that, you need to make an elliptical incision so you can ease the skin together.

If you do a search on this site, you will find tons of information on recovery.