- February 8, 2018 at 11:50 pm
Hi all! This isn't exactly the 'club' I wanted to be a part of….but here I am! Most of the google searches I've done have landed me on this forum and there appears to be lots of education folks here! I figured I'd join and see if someone can give me my results in something a jr high or highschool student may understand! :) Here's my background. 41 year old female, I started noticing a light brown spot on my forehead sometime in 2015-16…it was def noticable in photos by December 2016, but was only light brown, not really something that I thought was more than a sun spot or age spot. By March 2017, it had developed tiny dark specs in it and caught my attention. I use a lighted magnifing mirror and that def helps see things better! Fast forward through 2017 and the dark specs became larger and more noticable. Still was relatively 'small'. The light brown area was about .7cm but not a perfect circle and the dark brown specs made up less than 1/2 the area. I made an appt in Jan 2018 with dermatologist. He 'thought' it was going to be a lentigo or malignant lentigo (which he explained as not being the invasive type of melanoma). He did a shave biopsy that was .7 x .7 x .1 cm The results came back as malignant melanoma with .31mm thickness. Since the thickness is small, he felt I'd be fine to stay local and have it surgical removed. THe other option was to go to MD Anderson, which is about 3 hours away, but they thought it wouldn't be a priority (due to size) and I may have a longer wait. I have a consult Wed, Feb 14 with the dr about removal. I am not extremely worried, since it appears to be caught early! I am thankful that I went and got it checked when I did! My questions are as follows:
Any ideas on what size of area would be removed by WLE, for an area described above? (Doesn't matter but since it is on my face, I guess I'm a bit nervous!)
How do they know the depth is only .31mm? Does that mean the entire depth of tumor was contained in the biopsy and there isn't anything below that? (see note below about surgical margin status)
Anything else from the biopsy report stand out? I have no idea what it means. They did send the sample for additional testing but I don't know what that entails and don't have results from that yet.
Do all of the 'not identified' items mean there were not present or just couldn't be identified from the sample, or what?
Biopsy Results read as follows:
DX: Mid forehead shave: Malignant Melanoma
Surgical Margin Status: The lesion extends to the deep margin of the biopsy with follicular epithelial involvement.
Measured Thickness: .31mm
Dermal Mitotic Rate: No dermal mitoses identified
Ulceration: Not Identified
Growth Phase: Radial
Level of Invasion: 2
Microsatellitosis: Not Identified
Perineural Invaison: Not Identified
Lymph-vascular invasion: Not Identified
Tumor infiltrating lymphocytes: Brisk
Tumor regression: Not Identified
Associated nevus: Not Identified
Microscopic Examination: Sections show a thin biopsy of skin. There is a haphazard asymmetric proliferation of nested and contiguous individual melanocytes present at the dermal-epidermal juction. Atypical cells extend down adnexal epithelium and there are a few nests within the underlying dermis. There are dense associated lymphoid infiltrates. Lesional cells are hightlighed on Melan A stained sections. An appropriate control was examined.
Am I in line with what I should be doing….staying local and having WLE, close follow up with derm after and for years to come?? Any other thing I need to consider?
Anyone translate for me?? Thank you so much!
- February 9, 2018 at 1:28 am
So the depth is "at least" .31mm. You don't have a clean deep margin which means there is melanoma left behind and you will never know the exact depth. Once they shave through a margin, you've lost that info. There is no way to just "add" any remaining melanoma removed to the previous sample to determine the depth. Having said all that, it is a positive sign that at least to that depth, the lesion is in a radial growth phase. That means it is growing horizontally and doesn't have the characteristics of growing downward. All the other factors are good, nothing negative. Not identiied means that particular characteristic wasn't seen in the sample – and in general that is good.
I'm a bit torn on what I'd do if in your situation. My gut feel is that the lesion is probably very close to the depth that you have had removed and you'd be fine going local. However, that isn't the only possibility. It is possible that the lesion could be deeper. And if it were closer to .75mm or 1mm, you'd want to do a SLNB. Since you don't know the depth for certain, it is certainly a valid option to have the SLNB and hit MD Anderson.
- February 9, 2018 at 2:06 am
You have a mole growing for two years that is nearly 3/4 cm in diameter with unknown depth because your doctor performed a shaved biopsy on a suspected melanoma. I would advise a second opinion by a melanoma specialist. Chances are everything will be fine with just WLE, but an expert might recommend SNLB
- February 9, 2018 at 10:10 pm
Just going to echo what others have said here – they have given you very eloquent answers but I can't help it, I'm going to chime in. In future, never accept a shave biopsy because the worst case scenario – a melanoma being dissected at the base so true depth is never known – makes it impossible to ever tell true depth of lesion. This may sound inconsequential but depth is EVERYTHING – 1mm can make the difference between a relatively easy to treat melanoma and serious systemic disease. As it stands, you have a melanoma of the head/neck (bad – these are seen to be more dangerous than limbs or trunk), of unknown depth (bad – because that true depth will give you the most accurate diagnosis and also whether or not you should consider a sentinel lymph node biopsy to check for further spread). However, everything apart from this in your pathology report is quite positive – no ominous features like vertical growth or ulceration etc. So you have a mixed picture here, which is 100% to do with that sloppy biopsy technique of doing a shave biopsy on a suspected melanoma. You always need to demand a full excisional biopsy 2mm around the lesion – that's gold standard for suspected melanoma biopsy. I personally would consult with MD Anderson because of the 'bad' points I noted above – a head/neck melanoma of unknown depth.
- February 10, 2018 at 8:20 pm
Thank you! I have a consult for surgery on Wednesday. I think I will discuss with her my thoughts/worries. Hoping she can take her 'dr' hat off long enough to put herself in my shoes and think about what she would want done. Now that I know better, there won't be any additional shave biopsies in my future! I had no idea going in or I would have requested something different.
- February 10, 2018 at 10:09 pm
I honestly do not know why dermatologists won't consider an excisional or punch biopsy for suspicious lesions. My husband's derm, who is VERY educated and specializes in skin cancers, knows that DH has had two primary melanomas and still balks. Most of the time he'll tell me "oh I'm sure it's not melanoma so a shave will be fine".
- February 14, 2018 at 8:50 pm
Just a little update! I met with dr that would do my WLE today. I voiced my concerns and she read over my report. I asked her what SHE would do, if it were her. So…tomorrow she is going to do an excisional biopsy. I know 1+1 doesn't equal 2, but I am hoping we will atleast know a little more about depth. Hoping there isn't anything to report and that all I need to do is follow up with the WLE afterwards. If it comes back anywhere from .5 (ish…haven't settled on a # yet, hopefully it's much smaller so I won't have to be so worried!) or greater, I will head to MDA. Hopefully this is the right steps. Seems to give me a little peace of mind, atleast. Thanks for the replies!
- You must be logged in to reply to this topic.