› Forums › General Melanoma Community › Help with Path Report
- This topic has 27 replies, 4 voices, and was last updated 13 years, 4 months ago by
Janner.
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- August 9, 2012 at 7:43 pm
Hi, my friend's mom was recently diagnosed with melanoma. She has an appointment with a surgeon on Tuesday. Could anyone help us to understand the path report. The lady is 74 years old and in otherwise good health. It looks to me like it is a fairly thin melanoma but the Clark's level is high so I don't know?? Unfortunately, she had a shave biopsy and I know that's not good. Any help would be appreciated.
Femaile
74 year old
BUTTOCK, RIGHT:
MALIGNANT MELANOMA, BRESLOW DEPTH 1.1 MM (172.5)Hi, my friend's mom was recently diagnosed with melanoma. She has an appointment with a surgeon on Tuesday. Could anyone help us to understand the path report. The lady is 74 years old and in otherwise good health. It looks to me like it is a fairly thin melanoma but the Clark's level is high so I don't know?? Unfortunately, she had a shave biopsy and I know that's not good. Any help would be appreciated.
Femaile
74 year old
BUTTOCK, RIGHT:
MALIGNANT MELANOMA, BRESLOW DEPTH 1.1 MM (172.5)NOTE:
Clark Level: IV
Ulceration: Absent
Regression: Absent
Dermal Mitoses: 3 per square mmThe melanoma extends to one peripheral margin and closely approximates the base of the biopsy specimen. A re-excision is warranted. Multiple level sections have been examined.
CLINICAL DIAGNISIS AND HISTORY:
Nevus, R/O Atypia, (partial).GROSS DESCRIPTION:
Submitted is an irregular, pigmented specimen measuring 1.5 cm; cut into multiple strips. ml-pm/dkMICROSCPIC DESCRIPTION:
In this trisected shave specimen, there is a broad and assymmectrical melanocytic proliferation. The epidermis is hyperplastic, and solitary and haphazardly nested melanocytes are present along the dermo-epidermal junction and scattered above the junction across the entire breadth of the lesion. In the dermis, melanocytes are present in sheets and randomly distributed nests failing to display maturation. The melanocytes display enlarged vesicular nuclei with prominent nucleoli and abundant amounts of lightly pigmented and finely granular cytoplasm. They extend into the deep reticular dermis as small nests and scattered solitary cells, to a depth of 1.1 mm. Three dermal mitoses per square mm are indentified. A Melan-A stain highlights the asymmetry, pagetoid spread, and extension into the reticular dermis.
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- August 9, 2012 at 7:47 pm
Forgot to add – she had a PET scan and her right knee and right side of her neck lit up. She has had knee surgery in the past. I am thinking the right side of her neck is probably not related to the melanoma because it was on her buttock and it seems it would show up in the groin and not the neck. Is that correct?
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- August 9, 2012 at 7:47 pm
Forgot to add – she had a PET scan and her right knee and right side of her neck lit up. She has had knee surgery in the past. I am thinking the right side of her neck is probably not related to the melanoma because it was on her buttock and it seems it would show up in the groin and not the neck. Is that correct?
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- August 9, 2012 at 7:47 pm
Forgot to add – she had a PET scan and her right knee and right side of her neck lit up. She has had knee surgery in the past. I am thinking the right side of her neck is probably not related to the melanoma because it was on her buttock and it seems it would show up in the groin and not the neck. Is that correct?
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- August 9, 2012 at 7:48 pm
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- August 9, 2012 at 7:48 pm
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- August 9, 2012 at 7:48 pm
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- August 9, 2012 at 8:05 pm
There is no assuming anything concerning where melanoma will or can go. If the doc is telling you it can’t be in th neck because of where they found it in the backside, find another doc. Find a melanoma oncologist.-
- August 9, 2012 at 8:18 pm
She has an appointment with a specialist next week. I was thinking it would probably show up in the groin before it showed up in the neck. No one told her that. I know melanoma is a sneaky diesease and does what it wants to do, I was just thinking it might be unlikely to be in the neck. But I guess it can go anywhere.
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- August 9, 2012 at 8:18 pm
She has an appointment with a specialist next week. I was thinking it would probably show up in the groin before it showed up in the neck. No one told her that. I know melanoma is a sneaky diesease and does what it wants to do, I was just thinking it might be unlikely to be in the neck. But I guess it can go anywhere.
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- August 9, 2012 at 8:18 pm
She has an appointment with a specialist next week. I was thinking it would probably show up in the groin before it showed up in the neck. No one told her that. I know melanoma is a sneaky diesease and does what it wants to do, I was just thinking it might be unlikely to be in the neck. But I guess it can go anywhere.
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- August 9, 2012 at 8:05 pm
There is no assuming anything concerning where melanoma will or can go. If the doc is telling you it can’t be in th neck because of where they found it in the backside, find another doc. Find a melanoma oncologist. -
- August 9, 2012 at 8:05 pm
There is no assuming anything concerning where melanoma will or can go. If the doc is telling you it can’t be in th neck because of where they found it in the backside, find another doc. Find a melanoma oncologist. -
- August 10, 2012 at 12:22 am
Basically a stage I lesion at this point. (Pretty unusual to have a PET scan for this). In general, lesions over 1mm do a sentinel lymph node biopsy. This is where they test the first lymph node in the drainage basin to look for spread. If that were positive, then that is typically when scans might be done. If the SNB were positive, then you can discuss options like removing lymph nodes or other adjuvant treatment – or just monitoring.
As for the PET scan result, you are correct. PETs light up for inflammation, trauma and cancer among other things. Previous surgical sites often light up so the knee is unlikely to be of concern. The neck also would not be the first location to look for spread – either abdominal nodes or groin nodes are much more likely. In addition, neck lymph nodes swell for infection much more often than anywhere else. Never say never, and you didn't state the SUV on each site which indicates how "hot" that site is (higher numbers tend to be more suspect)… but I'd think that they are not worrying about Stage IV at this point. The next step is to find out if the melanoma has spread to the local lymph basin.
Good luck to your Mom. My Dad was 81 when diagnosed with stage II melanoma and my Mom was 84 when diagnosed with stage 0. Hopefully this is something that can just be removed with surgery!
Janner
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- August 11, 2012 at 12:52 am
Hard to know for sure with the cervical lymph nodes – I'm no expert at evaluating but I'd say those levels are intermediate. It could be something as simple as an infection, though. Best left to the experts who can examine her. BTW, I forgot to post something about the shave biopsy. Since it appears the deep margins was clear (although close), the shave biopsy is not really an issue. Shaves are only a problem when they cut through a lesion so the true depth can't be determined.
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- August 11, 2012 at 12:52 am
Hard to know for sure with the cervical lymph nodes – I'm no expert at evaluating but I'd say those levels are intermediate. It could be something as simple as an infection, though. Best left to the experts who can examine her. BTW, I forgot to post something about the shave biopsy. Since it appears the deep margins was clear (although close), the shave biopsy is not really an issue. Shaves are only a problem when they cut through a lesion so the true depth can't be determined.
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- August 11, 2012 at 12:52 am
Hard to know for sure with the cervical lymph nodes – I'm no expert at evaluating but I'd say those levels are intermediate. It could be something as simple as an infection, though. Best left to the experts who can examine her. BTW, I forgot to post something about the shave biopsy. Since it appears the deep margins was clear (although close), the shave biopsy is not really an issue. Shaves are only a problem when they cut through a lesion so the true depth can't be determined.
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- August 10, 2012 at 12:22 am
Basically a stage I lesion at this point. (Pretty unusual to have a PET scan for this). In general, lesions over 1mm do a sentinel lymph node biopsy. This is where they test the first lymph node in the drainage basin to look for spread. If that were positive, then that is typically when scans might be done. If the SNB were positive, then you can discuss options like removing lymph nodes or other adjuvant treatment – or just monitoring.
As for the PET scan result, you are correct. PETs light up for inflammation, trauma and cancer among other things. Previous surgical sites often light up so the knee is unlikely to be of concern. The neck also would not be the first location to look for spread – either abdominal nodes or groin nodes are much more likely. In addition, neck lymph nodes swell for infection much more often than anywhere else. Never say never, and you didn't state the SUV on each site which indicates how "hot" that site is (higher numbers tend to be more suspect)… but I'd think that they are not worrying about Stage IV at this point. The next step is to find out if the melanoma has spread to the local lymph basin.
Good luck to your Mom. My Dad was 81 when diagnosed with stage II melanoma and my Mom was 84 when diagnosed with stage 0. Hopefully this is something that can just be removed with surgery!
Janner
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- August 10, 2012 at 12:22 am
Basically a stage I lesion at this point. (Pretty unusual to have a PET scan for this). In general, lesions over 1mm do a sentinel lymph node biopsy. This is where they test the first lymph node in the drainage basin to look for spread. If that were positive, then that is typically when scans might be done. If the SNB were positive, then you can discuss options like removing lymph nodes or other adjuvant treatment – or just monitoring.
As for the PET scan result, you are correct. PETs light up for inflammation, trauma and cancer among other things. Previous surgical sites often light up so the knee is unlikely to be of concern. The neck also would not be the first location to look for spread – either abdominal nodes or groin nodes are much more likely. In addition, neck lymph nodes swell for infection much more often than anywhere else. Never say never, and you didn't state the SUV on each site which indicates how "hot" that site is (higher numbers tend to be more suspect)… but I'd think that they are not worrying about Stage IV at this point. The next step is to find out if the melanoma has spread to the local lymph basin.
Good luck to your Mom. My Dad was 81 when diagnosed with stage II melanoma and my Mom was 84 when diagnosed with stage 0. Hopefully this is something that can just be removed with surgery!
Janner
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