Malignant Melanoma Superficial Spreading with focal invasion just diagnosed
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Malignant Melanoma Superficial Spreading with focal invasion just diagnosed

› Forums › General Melanoma Community › Malignant Melanoma Superficial Spreading with focal invasion just diagnosed

  • Post
    • August 26, 2015 at 9:11 pm
    sk5647
    Participant

    Looking for some help/guidance or analysis on the following.

     

    I am a 35 year male.  I saw the dermatologist last week (my first visit ever) for a routine exam.  He noticed an area of suspicion on my back and scaped it off to be sent away for analysis.

     

    I recieved the results yesterday and picked up the pathology report also yesteday and wasn't expecting what he told me.  I have a follow-up 3 weeks from today to have more cut out to help ensure it is removed (Wide local excision with 1cm margin).  They also stated I would need to have checkup's every 6 months for the next 3 years.  They did not give me a stage.  In addition to self screenings, if there anything else I should be doing?  Do I need to have any additional test to ensure this has not spread?  I have a bit of an idea of the diagnosis below from my conversation with the doctor and research online.  Just looking for a bit of help on this as I am a bit nervous.  Also, what does the following statement indicate?  "It was difficult to distinguish this melanocytic lesion from a severely dysplastic compound nevus from invasive melanoma"  Thanks in advance for any guidance here and if there is anything else I should be doing or concerned about.

     

    Diagnosis

    Skin, left inferior upper back

    Malignant melanoma, superficial spreading with focal invasion

    Breslow's depth: 0.4mm

    Clarks Level III

    Ulceration: Not identified

    Mitotic rate: <1/mm2

    Lymphovascular invasion: Not identified

    Features of regression: Not identified

    Lymphocytic Host Response: Brisk

    Coexisting nevus: Possibly identified (dysplastic nevus)

    Margins: Free of melanoma

     

    Clinical info:

    Left inferior upper back – Shave, Reddish Brown variably pigmented macule, neoplasm of uncertain behavior vs dysplastic nevus

     

    Gross Description

    Specimen recieved in formalin identified as "Left Inferior Upper Back" and consists of a shave biopsy measuring 6x5mm.  The specimen is bisected and totally submitted in one casette

     

    Microscopic Description:

    There are irregular, junctional, melanocytic nests.  Additionally, there is an area that has an increased number of single unit melanocytes and a "zipper sign" is noted.  In the dermis, there is a focal area with similiar appearing melanocytes compatible with focal invasive melanoma.  Also in the dermis, there is chronic inflammation with melnophages.  It was difficult to distinguish this melanocytic lesion from a severely dysplastic compound nevus from invasive melanoma.  Multiple levels were examined.

Viewing 11 reply threads
  • Replies
      • August 26, 2015 at 11:59 pm
      JC
      Participant

      maybe another opinion from a dermatopathologist?  you can have your slides sent for another opinion if that would help distinguish melanoma from severely dysplastic

      • August 26, 2015 at 11:59 pm
      JC
      Participant

      maybe another opinion from a dermatopathologist?  you can have your slides sent for another opinion if that would help distinguish melanoma from severely dysplastic

      • August 26, 2015 at 11:59 pm
      JC
      Participant

      maybe another opinion from a dermatopathologist?  you can have your slides sent for another opinion if that would help distinguish melanoma from severely dysplastic

      • August 27, 2015 at 12:38 am
      CHD
      Participant

      This would be a great question for Janner, another member here who is knowledgeable about these types of lesions.  My own speculative guess, as a patient, not a medical provider, is that they are not completely sure whether yours qualifies as something that is not quite melanoma, or actual melanoma, which to my mind is a good thing (not the lack of clarity but the possibly not melanoma part).   At 0.4 mm, if it is melanoma, it is very thin, and that is an extremely good thing when it comes to melanoma.  Essentially, you would be stage I, and you would need wide local excision with 1 cm margins, and then they will want to follow you closely for skin checks for a few years, but your prognosis, with no ulceration, mitosis less than 1, and no regression, is very good, I think about 96% survival rate at 5 years.  It is because of that remaining 4% that, while small, is still a factor and you will want to be diligent about skin checks and followup.

      It is possible that asking for your pathology to be reviewed by another lab for a second opinion might help to establish your exact diagnosis, if there is any question about whether or not what you have is invasive melanoma or something else.  This might be a good question to ask on your followup visit in 3 weeks.  In fact, this is all worthy of clarification since I am definitely not an expert.   I don't think the results would change your treatment (WLE with 1 cm margins) if only to be on the safe side, but it definitely would not hurt to have this clarified.

      Good luck!

      • August 27, 2015 at 12:38 am
      CHD
      Participant

      This would be a great question for Janner, another member here who is knowledgeable about these types of lesions.  My own speculative guess, as a patient, not a medical provider, is that they are not completely sure whether yours qualifies as something that is not quite melanoma, or actual melanoma, which to my mind is a good thing (not the lack of clarity but the possibly not melanoma part).   At 0.4 mm, if it is melanoma, it is very thin, and that is an extremely good thing when it comes to melanoma.  Essentially, you would be stage I, and you would need wide local excision with 1 cm margins, and then they will want to follow you closely for skin checks for a few years, but your prognosis, with no ulceration, mitosis less than 1, and no regression, is very good, I think about 96% survival rate at 5 years.  It is because of that remaining 4% that, while small, is still a factor and you will want to be diligent about skin checks and followup.

      It is possible that asking for your pathology to be reviewed by another lab for a second opinion might help to establish your exact diagnosis, if there is any question about whether or not what you have is invasive melanoma or something else.  This might be a good question to ask on your followup visit in 3 weeks.  In fact, this is all worthy of clarification since I am definitely not an expert.   I don't think the results would change your treatment (WLE with 1 cm margins) if only to be on the safe side, but it definitely would not hurt to have this clarified.

      Good luck!

      • August 27, 2015 at 12:38 am
      CHD
      Participant

      This would be a great question for Janner, another member here who is knowledgeable about these types of lesions.  My own speculative guess, as a patient, not a medical provider, is that they are not completely sure whether yours qualifies as something that is not quite melanoma, or actual melanoma, which to my mind is a good thing (not the lack of clarity but the possibly not melanoma part).   At 0.4 mm, if it is melanoma, it is very thin, and that is an extremely good thing when it comes to melanoma.  Essentially, you would be stage I, and you would need wide local excision with 1 cm margins, and then they will want to follow you closely for skin checks for a few years, but your prognosis, with no ulceration, mitosis less than 1, and no regression, is very good, I think about 96% survival rate at 5 years.  It is because of that remaining 4% that, while small, is still a factor and you will want to be diligent about skin checks and followup.

      It is possible that asking for your pathology to be reviewed by another lab for a second opinion might help to establish your exact diagnosis, if there is any question about whether or not what you have is invasive melanoma or something else.  This might be a good question to ask on your followup visit in 3 weeks.  In fact, this is all worthy of clarification since I am definitely not an expert.   I don't think the results would change your treatment (WLE with 1 cm margins) if only to be on the safe side, but it definitely would not hurt to have this clarified.

      Good luck!

      • August 27, 2015 at 1:17 am
      sk5647
      Participant

      Thanks… I appreciate the answers.  All of that makes sense.  That was my assummption as well.  I will ask the question at my follow-up and see if that makes sense for another look.  But either way, I will have them do the wide local excision with 1cm margins to be extra safe which I assume they would do anyway if it was pre-cancerous.  Couple of last questions… should I be concerned with the Clarks level of III?  I know depth is the most important but I think i remember seeing Clark's level can be important if depth is under 1mm?  Also, should I have any concerns the initial biospy was a shave biopsy?  Or do the melanoma free margins ensure an initial proper depth measurement was obtained?  Only reason I ask if I thought I saw that a shave biopsy if usually not preferred if melanoma is suspected?

      Thanks again!

        • August 27, 2015 at 2:02 am
        CHD
        Participant

        These are again good questions for followup, but my take would tend to be the same as yours, that the shave biopsy, while not considered ideal, is probably fine with clear margins.  The Clark's level is controversial but I have read the same thing you have about lesions under 1 mm.  That said, I have also read more than once that some pathologists do not even include it anymore because it is highly subjective compared to the determination of Breslow depth. Your situation is also unique in that there seems to be some doubt about whether this is actually invasive melanoma.  If this were me, I think I would shelve this concern for the followup visit and get their thoughts.  It might not hurt to mention it when asking about sending the pathology off for a second opinion.

        Cheri

        • August 27, 2015 at 2:02 am
        CHD
        Participant

        These are again good questions for followup, but my take would tend to be the same as yours, that the shave biopsy, while not considered ideal, is probably fine with clear margins.  The Clark's level is controversial but I have read the same thing you have about lesions under 1 mm.  That said, I have also read more than once that some pathologists do not even include it anymore because it is highly subjective compared to the determination of Breslow depth. Your situation is also unique in that there seems to be some doubt about whether this is actually invasive melanoma.  If this were me, I think I would shelve this concern for the followup visit and get their thoughts.  It might not hurt to mention it when asking about sending the pathology off for a second opinion.

        Cheri

        • August 27, 2015 at 2:02 am
        CHD
        Participant

        These are again good questions for followup, but my take would tend to be the same as yours, that the shave biopsy, while not considered ideal, is probably fine with clear margins.  The Clark's level is controversial but I have read the same thing you have about lesions under 1 mm.  That said, I have also read more than once that some pathologists do not even include it anymore because it is highly subjective compared to the determination of Breslow depth. Your situation is also unique in that there seems to be some doubt about whether this is actually invasive melanoma.  If this were me, I think I would shelve this concern for the followup visit and get their thoughts.  It might not hurt to mention it when asking about sending the pathology off for a second opinion.

        Cheri

      • August 27, 2015 at 1:17 am
      sk5647
      Participant

      Thanks… I appreciate the answers.  All of that makes sense.  That was my assummption as well.  I will ask the question at my follow-up and see if that makes sense for another look.  But either way, I will have them do the wide local excision with 1cm margins to be extra safe which I assume they would do anyway if it was pre-cancerous.  Couple of last questions… should I be concerned with the Clarks level of III?  I know depth is the most important but I think i remember seeing Clark's level can be important if depth is under 1mm?  Also, should I have any concerns the initial biospy was a shave biopsy?  Or do the melanoma free margins ensure an initial proper depth measurement was obtained?  Only reason I ask if I thought I saw that a shave biopsy if usually not preferred if melanoma is suspected?

      Thanks again!

      • August 27, 2015 at 1:17 am
      sk5647
      Participant

      Thanks… I appreciate the answers.  All of that makes sense.  That was my assummption as well.  I will ask the question at my follow-up and see if that makes sense for another look.  But either way, I will have them do the wide local excision with 1cm margins to be extra safe which I assume they would do anyway if it was pre-cancerous.  Couple of last questions… should I be concerned with the Clarks level of III?  I know depth is the most important but I think i remember seeing Clark's level can be important if depth is under 1mm?  Also, should I have any concerns the initial biospy was a shave biopsy?  Or do the melanoma free margins ensure an initial proper depth measurement was obtained?  Only reason I ask if I thought I saw that a shave biopsy if usually not preferred if melanoma is suspected?

      Thanks again!

      • August 27, 2015 at 7:57 am
      stars
      Participant

      Hi – I think with the detail in the path report it's fairly certain to be a melanoma, but a second opinion can't hurt. Either way, in terms of the melanoma world you are in a pretty good position – it's either a misdiagnosed dysplastic nevus (mole) or a very thin/early melanoma with an excellent prognosis. I guess a 2nd opinion would be good because if it is the former, it's a huge weight off your mind.

      • August 27, 2015 at 7:57 am
      stars
      Participant

      Hi – I think with the detail in the path report it's fairly certain to be a melanoma, but a second opinion can't hurt. Either way, in terms of the melanoma world you are in a pretty good position – it's either a misdiagnosed dysplastic nevus (mole) or a very thin/early melanoma with an excellent prognosis. I guess a 2nd opinion would be good because if it is the former, it's a huge weight off your mind.

      • August 27, 2015 at 7:57 am
      stars
      Participant

      Hi – I think with the detail in the path report it's fairly certain to be a melanoma, but a second opinion can't hurt. Either way, in terms of the melanoma world you are in a pretty good position – it's either a misdiagnosed dysplastic nevus (mole) or a very thin/early melanoma with an excellent prognosis. I guess a 2nd opinion would be good because if it is the former, it's a huge weight off your mind.

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