› Forums › Cutaneous Melanoma Community › Help with my Pathology
- This topic has 12 replies, 3 voices, and was last updated 8 years, 4 months ago by
Janner.
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- December 18, 2015 at 11:49 pm
A year ago I was diagnosed with a stage 1a melanoma on my neck. Clarks 2 .22mm depth. Havent had any other issues or recurrences from that site and I have been going to my derm for follow up.
However, there as always been a mole on my face that I never liked the look of and I mentioned it to my Derm. My der is very skilled and he looked at it with his dermascope several times. He said its definitely NOT a melanoma but promised that it was at least mild to moderately atypical but because of my profession (acting on stage and film) he said it would probably be best to leave it and watch it because he didnt want to risk scarring.
I was still not comfortable with it so he said I should see a good plastic surgeon if I really wanted it removed. So a few days ago that is exactly what I did. My pathology came back on my health account today (havent heard from the actual Doc yet about it) and I am really confused and concerned. Here is my pathology. Maybe you all can help me figure out what it means. I REALLY don't want to have more removed or risk scarring my face more.
PATHOLOGY:
A. SKIN, RIGHT CHEEK, EXCISIONAL SPECIMEN: ATYPICAL LENTIGINOUS JUNCTIONAL MELANOCYTIC PROLIFERATION ON SOLAR-DAMAGED SKIN WITH FOCAL BASALOID ATYPIA AND CALCIFICATION OF THE DERMIS.
THE ATYPIA INVOLVES PERIPHERAL INKED TISSUE MARGINS. SEE MICROSCOPIC EXAMINATION.
MICROSCOPIC EXAM:
A. Multiple step sections of skin extend to the superficial subcutaneous tissue. There is a background of solar elastosis. There is an atypical junctional proliferation of single and focally apparently nested melanocytes with scattered moderate cytologic atypia, bridging of rete ridges and patchy confluency. Focal basaloid atypia not involving a peripheral inked tissue margin is noted. There is central calcification of the dermis which causes partial disruption of the specimen. Deeper step sections show similar findings. An immunohistochemical stain is performed with appropriate controls.* Melan-A highlights the atypical junctional proliferation on solar-damaged skin with at least moderate atypia. It raises the possibility of a precursor lesion of a more aggressive lesion such as melanoma in situ. We cannot make a definitive diagnosis of melanoma in this specimen. The lesion involves peripheral inked tissue margins. If a complete re-excision is not done at this time, then very close clinical follow up at this site with additional sampling or re-excision of any residual clinical or recurrent lesion is recommended, as clinically indicated. I assume this specimen is representative of the entire clinical lesion/process. Clinical correlation is required. I would be happy to discuss this case at any time.
Dr. Zarandona (also a dermatopathologist) studied this case. The above is a consensus diagnosis.
Thanks in advance for advice!
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- December 18, 2015 at 11:51 pm
Oh and it was removed with excision and stitched up. It was not a punch or shave biopsy.
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- December 19, 2015 at 11:12 am
My first suggestion would be to get a second opinion on the pathology, but thats already done (concensus). This is not what you want to hear, but I think you will need to get a little more skin excised, probably another 2mm margin excision. The excision is incomplete, and you just don't know what lies beyond the incompletely excised border of the mole. I speak from experience. My dr once did an incomplete punch biopsy which came back from path as dysplastic with full excision recommendedd. On full excision, A stage 1 melanoma lay just beyond the border. With your history (and mine), we simply cannot take the risk of incomplete excision. There's every chance that the full excision will reveal nothing and you can breath a sigh of relief, but in my view to leave an invomplete excision is madness. Yes, the fear of scarring is real and I respect that in your profession. But after my experience I will always want clean margins, no matter what the pathology says.
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- December 19, 2015 at 11:18 pm
Thaks for the reply. Im sorry that they almost mist that stage 1 on you! Im definitely going to follow up with my Plastic Surgeon and my Dermatologist this week and get their opinion on it. Im not too worried about it being a melanoma that is missed. I trust my Dermatologist as he is board certified and deals with several melanomas a week at least. I am also somewhat of a hypochondriac and when anything changes in my mind I go to him for advice. He told me his bar is so low on me because of my melanoma history and because of my anxiety that if he thought something was even the slightest risk he'd remove it to be safe and for my peace of mind. Even on lesions he would just watch on another patient.
Like I said when I first presented this lesion he said he was positive it wasnt a melanoma but if it was removed the pathology would probably want him to take more out and again because of my profession he didnt want to risk a bad scar. As I still had anxiety about it he referred me to a good plastic surgeon to minimize scarring.
Obviously if both Drs recommend re-excission then Ill have to bite the bullet and do it, but if they think watching and waiting is fine Ill go that route. As of now looking at the scar that is there, there isnt a speck of pigment to be seen, but Im no Doctor so we will see.
Anyone else want to weigh in on this before I see my Doctors next week? Janner?
I did read some studies apparently more and more derms these days no longer think mild or moderate atypia warrant re excission but its usually a Drs preference based off your history and skin type.
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- December 19, 2015 at 11:18 pm
Thaks for the reply. Im sorry that they almost mist that stage 1 on you! Im definitely going to follow up with my Plastic Surgeon and my Dermatologist this week and get their opinion on it. Im not too worried about it being a melanoma that is missed. I trust my Dermatologist as he is board certified and deals with several melanomas a week at least. I am also somewhat of a hypochondriac and when anything changes in my mind I go to him for advice. He told me his bar is so low on me because of my melanoma history and because of my anxiety that if he thought something was even the slightest risk he'd remove it to be safe and for my peace of mind. Even on lesions he would just watch on another patient.
Like I said when I first presented this lesion he said he was positive it wasnt a melanoma but if it was removed the pathology would probably want him to take more out and again because of my profession he didnt want to risk a bad scar. As I still had anxiety about it he referred me to a good plastic surgeon to minimize scarring.
Obviously if both Drs recommend re-excission then Ill have to bite the bullet and do it, but if they think watching and waiting is fine Ill go that route. As of now looking at the scar that is there, there isnt a speck of pigment to be seen, but Im no Doctor so we will see.
Anyone else want to weigh in on this before I see my Doctors next week? Janner?
I did read some studies apparently more and more derms these days no longer think mild or moderate atypia warrant re excission but its usually a Drs preference based off your history and skin type.
-
- December 19, 2015 at 11:18 pm
Thaks for the reply. Im sorry that they almost mist that stage 1 on you! Im definitely going to follow up with my Plastic Surgeon and my Dermatologist this week and get their opinion on it. Im not too worried about it being a melanoma that is missed. I trust my Dermatologist as he is board certified and deals with several melanomas a week at least. I am also somewhat of a hypochondriac and when anything changes in my mind I go to him for advice. He told me his bar is so low on me because of my melanoma history and because of my anxiety that if he thought something was even the slightest risk he'd remove it to be safe and for my peace of mind. Even on lesions he would just watch on another patient.
Like I said when I first presented this lesion he said he was positive it wasnt a melanoma but if it was removed the pathology would probably want him to take more out and again because of my profession he didnt want to risk a bad scar. As I still had anxiety about it he referred me to a good plastic surgeon to minimize scarring.
Obviously if both Drs recommend re-excission then Ill have to bite the bullet and do it, but if they think watching and waiting is fine Ill go that route. As of now looking at the scar that is there, there isnt a speck of pigment to be seen, but Im no Doctor so we will see.
Anyone else want to weigh in on this before I see my Doctors next week? Janner?
I did read some studies apparently more and more derms these days no longer think mild or moderate atypia warrant re excission but its usually a Drs preference based off your history and skin type.
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- December 19, 2015 at 11:12 am
My first suggestion would be to get a second opinion on the pathology, but thats already done (concensus). This is not what you want to hear, but I think you will need to get a little more skin excised, probably another 2mm margin excision. The excision is incomplete, and you just don't know what lies beyond the incompletely excised border of the mole. I speak from experience. My dr once did an incomplete punch biopsy which came back from path as dysplastic with full excision recommendedd. On full excision, A stage 1 melanoma lay just beyond the border. With your history (and mine), we simply cannot take the risk of incomplete excision. There's every chance that the full excision will reveal nothing and you can breath a sigh of relief, but in my view to leave an invomplete excision is madness. Yes, the fear of scarring is real and I respect that in your profession. But after my experience I will always want clean margins, no matter what the pathology says.
-
- December 19, 2015 at 11:12 am
My first suggestion would be to get a second opinion on the pathology, but thats already done (concensus). This is not what you want to hear, but I think you will need to get a little more skin excised, probably another 2mm margin excision. The excision is incomplete, and you just don't know what lies beyond the incompletely excised border of the mole. I speak from experience. My dr once did an incomplete punch biopsy which came back from path as dysplastic with full excision recommendedd. On full excision, A stage 1 melanoma lay just beyond the border. With your history (and mine), we simply cannot take the risk of incomplete excision. There's every chance that the full excision will reveal nothing and you can breath a sigh of relief, but in my view to leave an invomplete excision is madness. Yes, the fear of scarring is real and I respect that in your profession. But after my experience I will always want clean margins, no matter what the pathology says.
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- December 18, 2015 at 11:51 pm
Oh and it was removed with excision and stitched up. It was not a punch or shave biopsy.
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- December 18, 2015 at 11:51 pm
Oh and it was removed with excision and stitched up. It was not a punch or shave biopsy.
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- December 22, 2015 at 4:41 pm
You have a moderately atypical lesion without clean margins. There is NO CONSENSUS on margins required for moderately atypical lesions. Some derms require clean margins, others don't. My derm would want clean margins. If you want, you can just wait to see if the area continues to grow. It isn't an unreasonable solution, however if it grows, you may end up having to have larger margins taken later. The only other thing I can say is that the areas I've had biopsied and frozen on my face have healed very quickly and very unnoticeable.
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- December 22, 2015 at 4:41 pm
You have a moderately atypical lesion without clean margins. There is NO CONSENSUS on margins required for moderately atypical lesions. Some derms require clean margins, others don't. My derm would want clean margins. If you want, you can just wait to see if the area continues to grow. It isn't an unreasonable solution, however if it grows, you may end up having to have larger margins taken later. The only other thing I can say is that the areas I've had biopsied and frozen on my face have healed very quickly and very unnoticeable.
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- December 22, 2015 at 4:41 pm
You have a moderately atypical lesion without clean margins. There is NO CONSENSUS on margins required for moderately atypical lesions. Some derms require clean margins, others don't. My derm would want clean margins. If you want, you can just wait to see if the area continues to grow. It isn't an unreasonable solution, however if it grows, you may end up having to have larger margins taken later. The only other thing I can say is that the areas I've had biopsied and frozen on my face have healed very quickly and very unnoticeable.
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Tagged: cutaneous melanoma
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