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MIS or Stage 1a…Dermpathologist cant decide????
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MIS or Stage 1a…Dermpathologist cant decide????

› Forums › General Melanoma Community › MIS or Stage 1a…Dermpathologist cant decide????

  • Post
    • April 28, 2016 at 4:24 pm
    m355
    Participant

      This one is a doozy!!! As much as I would prefer a MIS, it appears to me a stage 1A since there is a breslow depth of .32.  They are treating as a stage 1 which I am okay with being aggressive.  I am having sent to my other dermapathologist back home for his review too.  Of the 4 derm path. 1 said MIS, 1 undecided, 2 for stage 1.  The mole appeared new or was a super light freckle (cant really tell on my professional pictures).  The 0 mitotic rate is throwing them off too…

      Here is lab report:

      A) Skin, right upper back, punch biopsy: Severely
      atypical compound melanocytic proliferation, see
      Comment.

      COMMENT:
      This is a worrisome lesion, with epidermal atypia
      (pagetoid extension, confluent growth) consistent with
      melanoma in situ and a dermal component that also
      demonstrates atypia with areas of morphologically
      similar cells to the epidermal component, but also some
       reassuring features (dispersion with increasing dermal
       depth, absence of mitoses). These findings engender a
      differential diagnosis that could reasonably include
      melanoma in situ evolving within a dysplastic nevus or
      a superfically invasive melanoma. Given this
      differential, it would be reasonable to treat this
      lesion as if it represents a malignant melanoma with
      the following prognostic factors: Breslow depth 0.32mm,
       Clark's level II, 0 mitoses/mm2, no ulceration.
       

      MICROSCOPIC DESCRIPTION:
      A) Sections show a punch biopsy with a compound
      melanocytic proliferation. The junctional component
      shows crowding, with fusion between adjacent rete and
      horizontal nests. Areas of upward extension of single
      melanocytes and nests are seen, and highlighted by
      Melan-A. Intraepidermal melanocytes show cytologic
      atypia, with nuclear enlargement and abundant
      cytoplasm. A patchy lymphohistiocytic inflammatory
      infiltrate is present. The lesion is free of the punch
      biopsy margin. Additional step sections are examined.
       

       

      Melan A test is positive
       

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    • Replies
        • April 28, 2016 at 5:21 pm
        Janner
        Participant

          Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

          • April 28, 2016 at 5:21 pm
          Janner
          Participant

            Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

            • April 28, 2016 at 5:21 pm
            Janner
            Participant

              Dermatopathology is as much an art as it is a science.  Since not all features in the dermis echo the negative features in the epidermis, I can see where this is debatable.  I don't see where there is any issue with mitosis.  It sounds like you could, for insurance and other purposes, legitimately say you had MIS removed.  (For those times when less is better).  But for yourself, you could treat it as stage 1a in terms of margins and followup.  It all sucks but either way, this is another early one.

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