Need help understanding Pathology report

First off, I'd ask your derm when he does a biopsy to either use a punch to begin with, or a big enough shave to remove the entire lesion (both width AND depth).  If you have a biopsy, there is never a reason not to remove the entire lesion…. well, mostly never.  I guess if the lesion is very large, a partial biopsy may be done.  But in general, I'd want him to remove the entire lesion in the first setting.

Spitz Nevi are typically found in people under 20 so it might be considered unusual for you to have a Spitz nevus at age 34.  Not saying it can't happen.  Spitz nevi are totally benign, but they look almost identical to melanoma under the microscope.  Is a dermatopathologist reading your slides?  Are you at a major cancer center/melanoma center?  If the final diagnosis is a Spitz Nevus, I could see getting a second opinion on the slides given your age.

Best wishes,

Janner

First off, I'd ask your derm when he does a biopsy to either use a punch to begin with, or a big enough shave to remove the entire lesion (both width AND depth).  If you have a biopsy, there is never a reason not to remove the entire lesion…. well, mostly never.  I guess if the lesion is very large, a partial biopsy may be done.  But in general, I'd want him to remove the entire lesion in the first setting.

Spitz Nevi are typically found in people under 20 so it might be considered unusual for you to have a Spitz nevus at age 34.  Not saying it can't happen.  Spitz nevi are totally benign, but they look almost identical to melanoma under the microscope.  Is a dermatopathologist reading your slides?  Are you at a major cancer center/melanoma center?  If the final diagnosis is a Spitz Nevus, I could see getting a second opinion on the slides given your age.

Best wishes,

Janner

First off, I'd ask your derm when he does a biopsy to either use a punch to begin with, or a big enough shave to remove the entire lesion (both width AND depth).  If you have a biopsy, there is never a reason not to remove the entire lesion…. well, mostly never.  I guess if the lesion is very large, a partial biopsy may be done.  But in general, I'd want him to remove the entire lesion in the first setting.

Spitz Nevi are typically found in people under 20 so it might be considered unusual for you to have a Spitz nevus at age 34.  Not saying it can't happen.  Spitz nevi are totally benign, but they look almost identical to melanoma under the microscope.  Is a dermatopathologist reading your slides?  Are you at a major cancer center/melanoma center?  If the final diagnosis is a Spitz Nevus, I could see getting a second opinion on the slides given your age.

Best wishes,

Janner

Hi,

I am SO sympathetic to your quest to get precise definitions for your case!  I know it feels like you need an advanced degree yourself to figure out your diagnoses!

I know I'm "late to the party" on this, but in any case, I wanted to second the point that a previous respondent made to you.  Yes–get a second opinion from a melanoma clinic!  If you don't know where to find one, I'm sure the MRF can help you.  I know of several myself:  Mass General in Boston, UCSF, Sloan Kettering in NYC, MD Anderson in Houston, and the Johns Hopkins Melanoma and Cutaneous Oncology Group are a few.  The last clinic is the one I used and even though Hopkins is huge, I felt that my case was handled very well.  Eventually, the doc I was seeing left and I went back to seeing my local dermatologist because I'd been with her for years and she excised my first melanoma.

All of my melanomas (5) have been caught early and all have been"in situ."  I have had further excisions of all of them until the surgeon hit "clean" margins.  I've also had further excisions on any and all dysplasias.

One thing that I wanted to share with you is that there is an ongoing debate among dermatologists about whether or not to excise "dysplastic nevi," if they're considered "mild."  Those, as you probably know by now, are moles that *may* become melanomas, or may remain dysplastic forever.  Some researchers balk at the idea that any mild-appearing (and how can they know just by looking with their naked eyes?) dysplasias should be biopsied at all, saying that patients are getting cut too much.  I can't tell you how vehementally I disagree with this opinion–I think it's totally irresponsible.

So far, I have had 280+ moles and freckles removed (that's over 12 years).  Of those, about 33% have had some degree of dysplasia, and I ahve had all of them excised with a punch biospy first and then with follow-up outpatient surgeries.  I did have the Mohs procedure (the "skin shavin" technique) once because I had a "severe displaysia" (just shy of a melanoma) on a toe and there was no skin to stich together.

I know that I've been extremely lucky.  I am absoutely vigilent with covering up and hats and sunscreen.  I am considering genetic testing for the BRAF gene but I'm not sure if my insurance co. will cover that (or set off alarm bells).

Please get in touch with me to let me know how you're doing or if you have anything else to share about all of this.  It's terrifying, but there is LOTS of support and knowledge out there to help you on this crazy journey!  I send you all best thoughts and wishes!!  Laurie

Hi,

I am SO sympathetic to your quest to get precise definitions for your case!  I know it feels like you need an advanced degree yourself to figure out your diagnoses!

I know I'm "late to the party" on this, but in any case, I wanted to second the point that a previous respondent made to you.  Yes–get a second opinion from a melanoma clinic!  If you don't know where to find one, I'm sure the MRF can help you.  I know of several myself:  Mass General in Boston, UCSF, Sloan Kettering in NYC, MD Anderson in Houston, and the Johns Hopkins Melanoma and Cutaneous Oncology Group are a few.  The last clinic is the one I used and even though Hopkins is huge, I felt that my case was handled very well.  Eventually, the doc I was seeing left and I went back to seeing my local dermatologist because I'd been with her for years and she excised my first melanoma.

All of my melanomas (5) have been caught early and all have been"in situ."  I have had further excisions of all of them until the surgeon hit "clean" margins.  I've also had further excisions on any and all dysplasias.

One thing that I wanted to share with you is that there is an ongoing debate among dermatologists about whether or not to excise "dysplastic nevi," if they're considered "mild."  Those, as you probably know by now, are moles that *may* become melanomas, or may remain dysplastic forever.  Some researchers balk at the idea that any mild-appearing (and how can they know just by looking with their naked eyes?) dysplasias should be biopsied at all, saying that patients are getting cut too much.  I can't tell you how vehementally I disagree with this opinion–I think it's totally irresponsible.

So far, I have had 280+ moles and freckles removed (that's over 12 years).  Of those, about 33% have had some degree of dysplasia, and I ahve had all of them excised with a punch biospy first and then with follow-up outpatient surgeries.  I did have the Mohs procedure (the "skin shavin" technique) once because I had a "severe displaysia" (just shy of a melanoma) on a toe and there was no skin to stich together.

I know that I've been extremely lucky.  I am absoutely vigilent with covering up and hats and sunscreen.  I am considering genetic testing for the BRAF gene but I'm not sure if my insurance co. will cover that (or set off alarm bells).

Please get in touch with me to let me know how you're doing or if you have anything else to share about all of this.  It's terrifying, but there is LOTS of support and knowledge out there to help you on this crazy journey!  I send you all best thoughts and wishes!!  Laurie

Hi,

I am SO sympathetic to your quest to get precise definitions for your case!  I know it feels like you need an advanced degree yourself to figure out your diagnoses!

I know I'm "late to the party" on this, but in any case, I wanted to second the point that a previous respondent made to you.  Yes–get a second opinion from a melanoma clinic!  If you don't know where to find one, I'm sure the MRF can help you.  I know of several myself:  Mass General in Boston, UCSF, Sloan Kettering in NYC, MD Anderson in Houston, and the Johns Hopkins Melanoma and Cutaneous Oncology Group are a few.  The last clinic is the one I used and even though Hopkins is huge, I felt that my case was handled very well.  Eventually, the doc I was seeing left and I went back to seeing my local dermatologist because I'd been with her for years and she excised my first melanoma.

All of my melanomas (5) have been caught early and all have been"in situ."  I have had further excisions of all of them until the surgeon hit "clean" margins.  I've also had further excisions on any and all dysplasias.

One thing that I wanted to share with you is that there is an ongoing debate among dermatologists about whether or not to excise "dysplastic nevi," if they're considered "mild."  Those, as you probably know by now, are moles that *may* become melanomas, or may remain dysplastic forever.  Some researchers balk at the idea that any mild-appearing (and how can they know just by looking with their naked eyes?) dysplasias should be biopsied at all, saying that patients are getting cut too much.  I can't tell you how vehementally I disagree with this opinion–I think it's totally irresponsible.

So far, I have had 280+ moles and freckles removed (that's over 12 years).  Of those, about 33% have had some degree of dysplasia, and I ahve had all of them excised with a punch biospy first and then with follow-up outpatient surgeries.  I did have the Mohs procedure (the "skin shavin" technique) once because I had a "severe displaysia" (just shy of a melanoma) on a toe and there was no skin to stich together.

I know that I've been extremely lucky.  I am absoutely vigilent with covering up and hats and sunscreen.  I am considering genetic testing for the BRAF gene but I'm not sure if my insurance co. will cover that (or set off alarm bells).

Please get in touch with me to let me know how you're doing or if you have anything else to share about all of this.  It's terrifying, but there is LOTS of support and knowledge out there to help you on this crazy journey!  I send you all best thoughts and wishes!!  Laurie

You can certainly be seen at a cancer center, but as long as your slides are being sent to a specialist, you're probably fine doing either.  I went to a normal derm until after my 2nd primary.  Then I went to a specialist.  But my normal derm used a well respected dermatopathologist so I felt like I was in good hands.  If you are happy where you are, stay.  If not, look elsewhere.  YOU have to feel good about this stuff, no one else.

If the spitz diagnosis is final, I'd send the stuff to Dr. Boris Bastian.  I think he's back at UCSF.  Expert in Spitz diagnosis among other things.

You can certainly be seen at a cancer center, but as long as your slides are being sent to a specialist, you're probably fine doing either.  I went to a normal derm until after my 2nd primary.  Then I went to a specialist.  But my normal derm used a well respected dermatopathologist so I felt like I was in good hands.  If you are happy where you are, stay.  If not, look elsewhere.  YOU have to feel good about this stuff, no one else.

If the spitz diagnosis is final, I'd send the stuff to Dr. Boris Bastian.  I think he's back at UCSF.  Expert in Spitz diagnosis among other things.

You can certainly be seen at a cancer center, but as long as your slides are being sent to a specialist, you're probably fine doing either.  I went to a normal derm until after my 2nd primary.  Then I went to a specialist.  But my normal derm used a well respected dermatopathologist so I felt like I was in good hands.  If you are happy where you are, stay.  If not, look elsewhere.  YOU have to feel good about this stuff, no one else.

If the spitz diagnosis is final, I'd send the stuff to Dr. Boris Bastian.  I think he's back at UCSF.  Expert in Spitz diagnosis among other things.