Newly Diagnosed In situ Need help with Pathology
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Newly Diagnosed In situ Need help with Pathology

› Forums › General Melanoma Community › Newly Diagnosed In situ Need help with Pathology

  • Post
    • March 24, 2018 at 6:54 am
    Shann
    Participant

    Hi

    I have recently been diagnosed with in situ melanoma.  Would like some help with my pathology please.  I have had a WLE.  It says the following:

    Excision Margins 3mm from 12 oclock 3.2 from 6 oclock.  

    Ulceration – Absent

    Pigmentation – present

    Mitotic n/a

    Lymp invasion n/a

    Distribution Focal

    Density Sparse

    Regression – Not identified

    Assoc benign naevus

    growth – nested, lentiginous and pagetoid

    subtype superficial spreading

    Excision of scar appears complete.

    Sections show skin excision with biopsy site changes.  There is residual atypical melanocytic proliferation along the dermoepidermal junction exhibiting nested, lentiginous and focally pagetoid growth pattersn and comprising highly atypical melanocytes with focal pigmentation.  No invasion is identified.  The features are those of insitu malignancy melanoma of superfical spreading subtype.  No evidence ulceration.

    My questions are the surgeon was taking 5mm but in the end it was 3.00 than 3.2 which he said was due to shrinkage.  Is this common?  And he said all margins clear all good and I would not need anymore taken.  He also said the border was mostly a-typical cells?  The lesion was taken from the side of my face in front of my ear. Thanks 

     

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      • March 24, 2018 at 3:52 pm
      Janner
      Participant

      Shrinkage does happen.  I have no idea if there is some type of "standard" you can expect, however.  Even if there were only atypical cells at the margins, "highly" atypical cells also have a recommended 5mm margins.  You're either going to have to accept your doctor's word that he took 5mm margins and continue to watch the scar for any pigment regrowth (what everyone with an excision should do) or decide you want more because you don't think your doc took enough.  That has to be your call combined with input from your doc.  Given the location, I could see the doc taking what he thought was just enough (i.e. 5mm) but not extra.

        • March 24, 2018 at 9:25 pm
        Shann
        Participant

        Thanks Janner for replying.  Yes I think your right that the surgeon took only the 5mm given the location.  He is happy with result, and feels it is adequate.  He is a plastic surgeon with a large interest in Melanomas, very highly regarded so I guess I just have to trust his judgement.  Also my original biopsy of it read Lentigo Maligna insitu but when it was fully taken out the new pathology read Superficial Spreading.  Is this common for subtypes to change, my surgeon said we just follow the new pathology which is from the whole excision.  I am being over cautious as I have a big family history of melanoma.  

        • March 24, 2018 at 11:43 pm
        Janner
        Participant

        I can't say I've ever heard the subtype ever change.  Lentio Maligna is typically something found on the face and most times only in the epidermis (in situ).  It typically takes a long time to become invasive.  SSM is also typically slow growing.  I'd probably trust the excision with the largest portion of lesion.  But either diagnosis doesn't change the prognosis or what you do – watch for pigment regrowth and watch for other lesions.

        • March 25, 2018 at 12:11 am
        Shann
        Participant

        yes i am on 3 monthly checks now and being extra vigilant with my skin.  Do you know what the terms focal and sparse mean in melanoma diagnosis?  Its in my pathology, also regression original report from biopsy showed regression but second pathology said it cannot be determined.

         

        • March 25, 2018 at 12:21 am
        Janner
        Participant

        Focal means a small centralized portion.  If it was seen on the biopsy but not the WLE, that would make sense.  Think of it as the tip of the pencil lead.  Sparse means just that – a few cells or mitotic figures (can't see report while typing this) but not prevalent throughout the entire sample.

        • March 26, 2018 at 12:21 am
        Shann
        Participant

        thanks janner, is the stage 0/1 email group still around that I have seen in other searches? 

         

        • March 26, 2018 at 1:26 am
        Janner
        Participant

        Sorry, no.  It kind of died a natural death.  Everyone moved on and I couldn't keep it populated enough to be active.  I've thought about doing a Facebook version but I keep trying to step back from all this.

        • March 26, 2018 at 2:45 am
        Shann
        Participant

        ok no worries, I understand.  Thanks for your help.

        • March 27, 2018 at 10:00 am
        Shann
        Participant

        HI Janner, just another question.  On my pathology I only have measurements from 12 oclock and 6 oclock, and I can't see any depth.  Although I've seen others and they will also have 3 oclock and 9 as well, and mention a depth. Is this common I know all pathology places are different, but was just wondering.

         

        • March 27, 2018 at 1:15 pm
        Janner
        Participant

        The 6/12 o'clock are just for orientation.  If you know where 6 and 12 are, you can figure out 3 and 9.  Basically that allows the doc to know which end is up, so to speak.  Mostly allows the docs to orient if margins aren't clear at one end/side.

        In situ has no depth, that's its definition.  Depth is only counted from the dermis deeper into the skin tissue  and in situ is confined to the epidermis.  In situ is Clark's Level 1, Breslow 0, stage 0.  All implied when you say in situ.

        • April 3, 2018 at 5:36 am
        Shann
        Participant

        Hi Janner , just wondering looking at my pathology do most insitu start in the dermoepidermal junction, is that common in most pathology reports.  It reads that I had highly atypical melancytes which are always melanoma is that correct? I’m trying to understand this terminolog. And the difference between stage 0 and 1 is the dermis is that right?

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