MRF-Logo2019-Horizontal-RGB
Need help with shave biopsy results
REGISTER
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Content within the patient forum is user-generated and has not been reviewed by medical professionals. Other sections of the Melanoma Research Foundation website include information that has been reviewed by medical professionals as appropriate. All medical decisions should be made in consultation with your doctor or other qualified medical professional.

Need help with shave biopsy results

› Forums › Cutaneous Melanoma Community › Need help with shave biopsy results

  • Post
    • March 20, 2018 at 10:20 am
    Casey301
    Participant

      Hi all,

      I recently had a shave biopsy, I believe it was a deep shave. I didnt know that an excision is suggested when a mole is suspicious, so now I am questioning why the doctor removed it with a shave biopsy. My pathology results are:

      diagnosis: compound nevus with moderate atypia at the dermoepidermal junction, dysplastic nevus, see note.

      note: the lesion appears narrowly excised (focally very close to the base). If any pigment remains or recurs at this site, complete conservative re-excision would be prudent. 

      Gross description: the specimen grossly was oval shaped, measuring 6 x 5 mm on the surface and 1 mm deep. It was divided into two sections on the long axis. All of the tissue was submitted for processing. 

      Miscroscopic description: there is elongation of the rete ridges with atypical melanocytic proliferation in single cells and nests. The epidermal component is seen to extend beyond the confines of the dermal component. Papillary fibrosis is noted. Dermal nests show maturation. 

      The report doesnt seem to mention if its definitely not malignant or not. Do I need an excision to be 100% sure? Or can I be sure this isnt melanoma? I made an apt with my doctor anyway to discuss the results and ask for an excision biopsy. I would like it all removed anyway. I didnt understand what narrowly excised and focally very close to the base meant. It sounded like the shave wasnt adequate?

      any help would be appreciated, thanks. 

    Viewing 2 reply threads
    • Replies
        • March 20, 2018 at 10:23 am
        Casey301
        Participant

          I also forgot to ask if the dermatologist does the excisional biopsy or do I need to go to a specialized surgeon and ask for it. Thanks. 

            • March 20, 2018 at 3:15 pm
            Janner
            Participant

              Some derms won't do wide excisions.  But if yours does, then I'd have no problem letting them do this.  I think it is overkill to have to go to a plastic surgeon to take margins.  I've had at least 10 atypical moles removed and 3 melanomas and all were done by the derms who did the biopsy.  The exception for me might be if the location were on the face.

              • March 20, 2018 at 4:14 pm
              bjeans
              Participant

                Unrelated to the OP, but one other exception – the wide local excision near my husband's clavicle was large and deep enough that the surgeon brought in a plastic surgeon – just to close – with a rotating flap to promote better healing. My interpretation: that the skin isn't as elastic there as in other areas. I wondered if insurance would have a problem with it, but our surgeon said it was medically necessary so they shouldn't blink – and they didn't. 

                • March 20, 2018 at 4:41 pm
                Janner
                Participant

                  Totally correct, there are areas tougher to close than others.  Anatomy does play a role.  In this case, this excision isn't for melanoma but for an atypical so the margins would be very small – more on the lines of an excisional biopsy.  Derms either do or don't and if your derm does, there is no reason to have to go to a specialist unless that's really the way you want to go.  If the derm notes a difficulty based on anatomy, go with his/her expertise.

                  • March 20, 2018 at 4:57 pm
                  bjeans
                  Participant

                    Absolutely, and I the info you provided was perfect. I was just uncessarily segueing into plastic surgery exceptions, thinking if anyone out there was wondering why a surgeon would bring in a plastic surgeon to close a WLE, it was one reason.

                  • March 20, 2018 at 3:10 pm
                  Janner
                  Participant

                    This is not malignant.  The diagnosis is specific that this is a moderately dysplastic or atypical nevus.  In all likelihood, it would never have become melanoma.  However, there is a higher risk than a totally benign nevus becoming melanoma.  In general (and this is not universal among docs), you want clear margins for mild atypia, clear to conservative margins for moderate atypia, and 5mm margins for severe atypia.  Severely atypical moles have the highest risk to change to melanoma.  The vast majority of atypical moles do not become melanoma. 

                    So as for yours, the pathologist is saying you do have clear but very close margins.  You could choose to have it excised again or you could just watch the area.  If there is any pigment that returns, have it excised then.  I personally don't think there is much risk in just watching a moderately atypical biopsy area for regrowth but you need to do what makes you feel comfortable.  Some docs would say excise, most would be fine with just leaving as is.  Again, no universal concensus on atypical excisions.

                    • March 20, 2018 at 8:21 pm
                    Casey301
                    Participant

                      Thanks everyone for your responses. I was confused as to what “focally very close to the base” meant. Does that mean the shave wasnt that deep?

                      I have read some doctors do excisions on moderate atypia moles and some do not. I would just rather fully remove it, since I have a lot of other health problems to begin with. But I do not know if she will. 

                  Viewing 2 reply threads

                  Tagged: 

                  • You must be logged in to reply to this topic.
                  About the MRF Patient Forum

                  The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

                  The information on the forum is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

                  Popular Topics