Help with Pathology Report
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Help with Pathology Report

› Forums › General Melanoma Community › Help with Pathology Report

  • Post
    • March 5, 2012 at 5:23 pm
    IMAlawMan
    Participant
    Hello everyone,

    I had a mole removed and the following pathology report came back:

    1) The specimen is a punch biopsy of skin present as as multiple H&E sections on one side. The pathological process is that of a proliferation of melanocytes confined to the epidermis. A single nevomelanocytic nest is also present within the superficial dermis, best appreciated upon the examination with special stains. Lesional cells are arranged in plump nests with foci of pagetoid extension noted. May of the nests are enlarged and demonstrate bridging between adjacent rete ridges. Atypical cells also extend down follicular epithelium to ally. Within the dermis are infiltrative lymphocytes and histiocytes with focal fibrosis.

    2) The histologic feature on H&E staining are quite concernIng, with markedly atypical cells a focus of pagetoid extension and prominent architectural disorder. However the overall immunohistochemical staining characteristics are reassuring. Because this lesion extends to the lateral surgical margins and because of its uncertain biological behavior, re-excision to ensure its complete removal and to allow for further histologic evaluation is strongly recommended.

    Doctor wants to take more out and says that if it was melanoma, they would have said melanoma.

    Any help you guys could provide would be greatly appreciated.

    Thank You in advance.

Viewing 2 reply threads
  • Replies
      • March 5, 2012 at 8:00 pm
      Janner
      Participant

      You didn't actually state the final diagnosis so it is a bit hard to interpret the comments.  But your doctor is right about one thing.  If it doesn't say melanoma, it isn't.  Since you didn't have clear margins, re-excision is appropriate.  If the lesions is considered "severely atypical" (this is where including the diagnosis would have helped), then you would want 5mm margins.  Other than that, at least clear margins would be appropriate.

      Best wishes,

      Janner

        • March 5, 2012 at 8:05 pm
        IMAlawMan
        Participant
        Hi Janner-

        Thanks for your help. I included everything from the pathology report. Doctor says that it is very abnormal, but not melanoma. Is it possible that after the second excision, results could come back as melanoma?

        I know I must sound like a worried pansy, especially compared the the strong individuals on this forum faced with much worse than I, but I’d like a little piece of mind if I can get it.

        Thanks Again

        • March 5, 2012 at 8:12 pm
        Janner
        Participant

        Somewhere on the report there should be a "Final Diagnosis".  That's the part that is missing. 

        It's very unlikely that the edge of the lesion (lateral margin) would have melanoma when the original lesion did not.  But you don't want to leave abnormal cells behind to mutate later.  Best to get the entire lesion removed now.  I wouldn't worry about it being melanoma at this time.

        • March 5, 2012 at 9:18 pm
        IMAlawMan
        Participant
        Strangely, no final diagnosis is included. Thank you for your help. I feel much better.
        • March 5, 2012 at 9:18 pm
        IMAlawMan
        Participant
        Strangely, no final diagnosis is included. Thank you for your help. I feel much better.
        • March 5, 2012 at 9:18 pm
        IMAlawMan
        Participant
        Strangely, no final diagnosis is included. Thank you for your help. I feel much better.
        • March 5, 2012 at 10:37 pm
        IMAlawMan
        Participant
        So basically, they are saying that the cells are abnormal, but not melnoma and that they recommend more removal because the entire thing wasn’t taken out?
        • March 6, 2012 at 3:48 am
        Janner
        Participant

        Yes.  In general, you want clear margins for a mildly atypical lesion, clear to conservative (2-3mm) margins for moderately atypical lesions, and 5mm margins for severely atypical lesions.  There is a lot of variation on recommended margins for mild and moderate, but severely atypical usually has 5mm margins.  Since your margins weren't clear, you want at least the involved portion removed.

        • March 6, 2012 at 3:48 am
        Janner
        Participant

        Yes.  In general, you want clear margins for a mildly atypical lesion, clear to conservative (2-3mm) margins for moderately atypical lesions, and 5mm margins for severely atypical lesions.  There is a lot of variation on recommended margins for mild and moderate, but severely atypical usually has 5mm margins.  Since your margins weren't clear, you want at least the involved portion removed.

        • March 6, 2012 at 3:48 am
        Janner
        Participant

        Yes.  In general, you want clear margins for a mildly atypical lesion, clear to conservative (2-3mm) margins for moderately atypical lesions, and 5mm margins for severely atypical lesions.  There is a lot of variation on recommended margins for mild and moderate, but severely atypical usually has 5mm margins.  Since your margins weren't clear, you want at least the involved portion removed.

        • March 5, 2012 at 10:37 pm
        IMAlawMan
        Participant
        So basically, they are saying that the cells are abnormal, but not melnoma and that they recommend more removal because the entire thing wasn’t taken out?
        • March 5, 2012 at 10:37 pm
        IMAlawMan
        Participant
        So basically, they are saying that the cells are abnormal, but not melnoma and that they recommend more removal because the entire thing wasn’t taken out?
        • March 5, 2012 at 8:12 pm
        Janner
        Participant

        Somewhere on the report there should be a "Final Diagnosis".  That's the part that is missing. 

        It's very unlikely that the edge of the lesion (lateral margin) would have melanoma when the original lesion did not.  But you don't want to leave abnormal cells behind to mutate later.  Best to get the entire lesion removed now.  I wouldn't worry about it being melanoma at this time.

        • March 5, 2012 at 8:12 pm
        Janner
        Participant

        Somewhere on the report there should be a "Final Diagnosis".  That's the part that is missing. 

        It's very unlikely that the edge of the lesion (lateral margin) would have melanoma when the original lesion did not.  But you don't want to leave abnormal cells behind to mutate later.  Best to get the entire lesion removed now.  I wouldn't worry about it being melanoma at this time.

        • March 5, 2012 at 8:05 pm
        IMAlawMan
        Participant
        Hi Janner-

        Thanks for your help. I included everything from the pathology report. Doctor says that it is very abnormal, but not melanoma. Is it possible that after the second excision, results could come back as melanoma?

        I know I must sound like a worried pansy, especially compared the the strong individuals on this forum faced with much worse than I, but I’d like a little piece of mind if I can get it.

        Thanks Again

        • March 5, 2012 at 8:05 pm
        IMAlawMan
        Participant
        Hi Janner-

        Thanks for your help. I included everything from the pathology report. Doctor says that it is very abnormal, but not melanoma. Is it possible that after the second excision, results could come back as melanoma?

        I know I must sound like a worried pansy, especially compared the the strong individuals on this forum faced with much worse than I, but I’d like a little piece of mind if I can get it.

        Thanks Again

      • March 5, 2012 at 8:00 pm
      Janner
      Participant

      You didn't actually state the final diagnosis so it is a bit hard to interpret the comments.  But your doctor is right about one thing.  If it doesn't say melanoma, it isn't.  Since you didn't have clear margins, re-excision is appropriate.  If the lesions is considered "severely atypical" (this is where including the diagnosis would have helped), then you would want 5mm margins.  Other than that, at least clear margins would be appropriate.

      Best wishes,

      Janner

      • March 5, 2012 at 8:00 pm
      Janner
      Participant

      You didn't actually state the final diagnosis so it is a bit hard to interpret the comments.  But your doctor is right about one thing.  If it doesn't say melanoma, it isn't.  Since you didn't have clear margins, re-excision is appropriate.  If the lesions is considered "severely atypical" (this is where including the diagnosis would have helped), then you would want 5mm margins.  Other than that, at least clear margins would be appropriate.

      Best wishes,

      Janner

Viewing 2 reply threads

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