› Forums › Cutaneous Melanoma Community › pathology for my initial biopsies
- This topic has 10 replies, 2 voices, and was last updated 12 years, 10 months ago by
CAdesiree.
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- June 13, 2011 at 9:34 pm
i had posted w questions right after i got my initial pathology reports for my biopsies. a bunch of you asked that i post the pathology bc it would help you answer my questions. i dont have a scanner, so im slow. but this is my original pathology report. my derm did MOHS and reconstruct… but i am seeking a second opinion bc my derm stopped communicating after the biopsies came back malignant melanoma. if these reports raise any flags for any reason please let me know. i am still working w my insurance on getting my second opinion.
i had posted w questions right after i got my initial pathology reports for my biopsies. a bunch of you asked that i post the pathology bc it would help you answer my questions. i dont have a scanner, so im slow. but this is my original pathology report. my derm did MOHS and reconstruct… but i am seeking a second opinion bc my derm stopped communicating after the biopsies came back malignant melanoma. if these reports raise any flags for any reason please let me know. i am still working w my insurance on getting my second opinion. any help with appropriate questions or concerns is greatly appreciated. i am really concerned bc i see that melanoma survivors are at a much greater risk of breast cancer (that has already taken most of the women in my family).
CLINICAL INFORMATION:
A) r/o dn. m. m.
B) central lesion, r/o dn vs. mmf
DIAGNOSIS:
A) SKIN, LEFT UPPER BACK (BIOPSY)
-MALIGNANT MELANOMA IN-SITU, EXTENDING TO THE
PERIPHERAL MARGINS (SEE COMMENT)
COMMENT:
WITH MULTIPLE STEP SECTIONS IN DEEPER INTO
THE TISSUE, NO FOCAL INVASION OF THE DERMIS IS
IDENTIFIED.
B) SKIN, LEFT UPPER BACK CENTRAL (BIOPSY)
-MALIGNANT MELANOMA OF SUPERFICIAL SPREADING TYPE,
INVASIVE TO A BRESLOW'S DEPTH OF 0.72 MM.,
CLARK'S LEVEL III
-SHOWING NO ULCERATION, A MITOTIC INDEX OF
2 PER MM. SQUARE AND A BRISK TUMOR INFILTRATING
LYMPHOCYTOSIS
-DEMONSTRATING NO LYMPHOVASCULAR INVASION OR
PERINEURAL INVASION OR TUMOR REGRESSION
-EXTENDING TO PERIPHERAL MARGINS
SYNOPTIC REPORT:
SPECIMEN LATERALITY: LEFT
TUMOR SITE: UPPER BACK
TUMOR SIZE: NOT GROSSLY IDENTIFIED
MACROSCOPIC SATELLITE NODULE(S): INTERMEDIATE
HISTOLOGIC TYPE: SUPERFICIAL SPREADING MELANOMA
MAXIMUM TUMOR THICKNESS: 0.72 MM. BRESLOW
ULCERATION: NOT IDENTIFIED
MARGINS: EXTENDING TO THE PERIPHERAL MARGINS
MITOTIC INDEX: 2 PER MM. SQUARE
MICROSATELLITOSIS: NOT IDENTIFIED
LYMPH-VASCULAR INVASION: NOT IDENTIFIED
PERINEURAL INVASION: NOT IDENTIFIED
TUMOR REGRESSION: NOT IDENTIFIED
TUMOR INFILTRATING LYMPHOCYTOSIS: BRISK
LYMPH NODES: NOT APPLICABLE
PATHOLOGIC STAGING (pTNM): NOT APPLICABLE
REPORT NOTES: KEY PORTIONS OF THIS CASE HAVE BEEN ADDITIONALLY
REVIEWED BY ONE OR MORE DERMATOPATHOLOGISTS
PATHOLOGIST: Board Certified Dermatology and Dermatopathology
GROSS DESCRIPTION:
A) Specimen, labeled as "L upper back" is received in
formalin and identified as "my name".
The specimen consists of a brown punch biopsy,
measuring 0.2 cm in diameter and 0.5cm in
depth. The specimen is entirely submitted in one
cassette(s).
B) Specimen, labeled as "l upper back central lesion"
is received in formalin and identified as
"my name". The specimen consists of a
brown punch biopsy, measuring 0.2 cm in diameter
and 0.5 cm in depth. The specimen is entirely
submitted in one cassette(s).
- Replies
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- June 13, 2011 at 9:37 pm
i almost forgot… the derm tried to tell me its not possible for one lesion to have 2 different pathologies… but they do… bc both these biopsies were from the same lesion. i was concerned bc he biopsied the "center" of the lesion, but not the area where the original mole was that changed into said lesion. i hope that makes sense…
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- June 13, 2011 at 10:06 pm
These reports don't reveal anything new. Your depth is 0.72mm and that's what you have to work with. Since he did Mohs, I'm assuming there are no additional pathology reports that could or would show any greater depth. Most melanoma patients have a wide excision where the tissue can again be analyzed and stained looking for additional depth. Mohs doesn't really give you that chance. Even if he did not get the area you said that had most changed, the likelihood of it being significantly different than 0.72 is probably low. The second biopsy from the edge showing in situ is pretty consistent with most lesions if they were analyzed in separate biopsies like yours. (Many lesions are not big enough to have multiple punch biopsies done – my 3 certainly haven't been). You don't have two different pathologies – because the deepest one IS your pathology. The other area was just not as mature yet and doesn't count in the final diagnosis. You go with what you know. Breslow 0.72mm, Stage IB.
Best wishes,
Janner
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- June 13, 2011 at 10:42 pm
thank you janner. my derm did NOT tell me that MOHS didnt allow him the chance to know pathology if any different than intial biopsy. instead when i recv'd the pathology and asked how one lesion could have 2 different pathologies he said it wasnt possible. that was my first red flag w this derm… bc i was holding report that showed otherwise. i am fighting with my insurance to get a second opinion… the dr i found is female & specializes w melanoma… my insurance cant figure out if they cover new dr or not… but the cancer center says they take my insurance… i appreciate your help. thanks again.
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- June 13, 2011 at 10:57 pm
"instead when i recv'd the pathology and asked how one lesion could have 2 different pathologies he said it wasnt possible. that was my first red flag w this derm… bc i was holding report that showed otherwise".
Just want to clarify that you DON'T have 2 pathologies. You have one. You might have two reports, but you get ONE stage for each primary lesion and that is the deepest depth found. So, you get to ignore your in situ pathology report as all melanomas have depth differences as you move outward. The in situ report is meaningless when you have a second report showing 0.72mm depth so you only use the 0.72mm report. This is your only pathology. Don't let the two biopsies confuse you – they don't confuse your doctor (or me :). While you might have considered it a red flag with the derm, I agree with the doc that you only have one pathology… the deepest. The red flag that was raised for me was the use of Mohs surgery on an area showing depth and not in a cosmetically significant area. THAT was my red flag, not two pathology reports – oh, and the fact that this doc can't communicate with you! Good luck on getting your second opinion!
Janner
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- June 13, 2011 at 10:57 pm
"instead when i recv'd the pathology and asked how one lesion could have 2 different pathologies he said it wasnt possible. that was my first red flag w this derm… bc i was holding report that showed otherwise".
Just want to clarify that you DON'T have 2 pathologies. You have one. You might have two reports, but you get ONE stage for each primary lesion and that is the deepest depth found. So, you get to ignore your in situ pathology report as all melanomas have depth differences as you move outward. The in situ report is meaningless when you have a second report showing 0.72mm depth so you only use the 0.72mm report. This is your only pathology. Don't let the two biopsies confuse you – they don't confuse your doctor (or me :). While you might have considered it a red flag with the derm, I agree with the doc that you only have one pathology… the deepest. The red flag that was raised for me was the use of Mohs surgery on an area showing depth and not in a cosmetically significant area. THAT was my red flag, not two pathology reports – oh, and the fact that this doc can't communicate with you! Good luck on getting your second opinion!
Janner
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- June 13, 2011 at 10:42 pm
thank you janner. my derm did NOT tell me that MOHS didnt allow him the chance to know pathology if any different than intial biopsy. instead when i recv'd the pathology and asked how one lesion could have 2 different pathologies he said it wasnt possible. that was my first red flag w this derm… bc i was holding report that showed otherwise. i am fighting with my insurance to get a second opinion… the dr i found is female & specializes w melanoma… my insurance cant figure out if they cover new dr or not… but the cancer center says they take my insurance… i appreciate your help. thanks again.
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- June 13, 2011 at 10:06 pm
These reports don't reveal anything new. Your depth is 0.72mm and that's what you have to work with. Since he did Mohs, I'm assuming there are no additional pathology reports that could or would show any greater depth. Most melanoma patients have a wide excision where the tissue can again be analyzed and stained looking for additional depth. Mohs doesn't really give you that chance. Even if he did not get the area you said that had most changed, the likelihood of it being significantly different than 0.72 is probably low. The second biopsy from the edge showing in situ is pretty consistent with most lesions if they were analyzed in separate biopsies like yours. (Many lesions are not big enough to have multiple punch biopsies done – my 3 certainly haven't been). You don't have two different pathologies – because the deepest one IS your pathology. The other area was just not as mature yet and doesn't count in the final diagnosis. You go with what you know. Breslow 0.72mm, Stage IB.
Best wishes,
Janner
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- June 13, 2011 at 9:37 pm
i almost forgot… the derm tried to tell me its not possible for one lesion to have 2 different pathologies… but they do… bc both these biopsies were from the same lesion. i was concerned bc he biopsied the "center" of the lesion, but not the area where the original mole was that changed into said lesion. i hope that makes sense…
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