› Forums › General Melanoma Community › Pathology report confusion
- This topic has 18 replies, 3 voices, and was last updated 12 years, 7 months ago by
becky15.
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- May 17, 2012 at 9:33 pm
I am from the UK and have recently been diagnosed with an SSM stage 1a on my leg, Breslow depth 0.72mm, no ulceration, no mitosis, no regression.
I am from the UK and have recently been diagnosed with an SSM stage 1a on my leg, Breslow depth 0.72mm, no ulceration, no mitosis, no regression.
I am very confused about my pathology report which states an "invasive radial growth phase" for the growth phase but also Clarks 4. This seems contradictory to me and my consultant has not been much help in clarifying this, saying that it must have a vertical growth element. Further down on my report it says, against where the mitotic rate and tumour infiltrating lymphocyte figures are shown, "(VGP only) – N/A" and then goes on to note in brackets "0 per mm squared" for mitotic rate and "non-brisk" for TIL.
Can anyone clarify this apparent contradiction?
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- May 18, 2012 at 12:02 am
Hi!
I am from UK as well and I have 1a radial growth phase, no mitosis ,no ulceration.#
I asked my Doctor about radial /vertical growth and he said it is possible to have invasive melanoma woth NO vertical component (it is cells characteristics , cells are unable to spread in radial growth and here is no tumor agression).
Which hospital are you consulting in?
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- May 18, 2012 at 12:02 am
Hi!
I am from UK as well and I have 1a radial growth phase, no mitosis ,no ulceration.#
I asked my Doctor about radial /vertical growth and he said it is possible to have invasive melanoma woth NO vertical component (it is cells characteristics , cells are unable to spread in radial growth and here is no tumor agression).
Which hospital are you consulting in?
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- May 18, 2012 at 12:02 am
Hi!
I am from UK as well and I have 1a radial growth phase, no mitosis ,no ulceration.#
I asked my Doctor about radial /vertical growth and he said it is possible to have invasive melanoma woth NO vertical component (it is cells characteristics , cells are unable to spread in radial growth and here is no tumor agression).
Which hospital are you consulting in?
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- May 18, 2012 at 3:13 am
Can you post the entire report? It's hard to even form an opinion with just bits and pieces. In general, though, I would expect any lesion with Clark Level IV to be vertical growth. I can't say I've ever seen a radial growth lesion that deep posted here. They are typically only Clark's Level II and usually thinner than yours. Can't say it can't happen, but just saying I've seen a ton of reports here and those stats just don't seem consistent.
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- May 18, 2012 at 3:13 am
Can you post the entire report? It's hard to even form an opinion with just bits and pieces. In general, though, I would expect any lesion with Clark Level IV to be vertical growth. I can't say I've ever seen a radial growth lesion that deep posted here. They are typically only Clark's Level II and usually thinner than yours. Can't say it can't happen, but just saying I've seen a ton of reports here and those stats just don't seem consistent.
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- May 18, 2012 at 3:13 am
Can you post the entire report? It's hard to even form an opinion with just bits and pieces. In general, though, I would expect any lesion with Clark Level IV to be vertical growth. I can't say I've ever seen a radial growth lesion that deep posted here. They are typically only Clark's Level II and usually thinner than yours. Can't say it can't happen, but just saying I've seen a ton of reports here and those stats just don't seem consistent.
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- May 18, 2012 at 7:58 am
Thank you Janner and Natasha.
Here is the my report- I did not get a second opinion as the writer is a dermatopathologist and I have already had the WLE. SLNB is not offered in the UK for lesions under 1mm unless they are ulcerated.
This punch biopsy of skin is non-ulcerated and contains at least an in-situ SSm with a superficial dermal component showing some atypia which is indefinite for invasive melanoma on the initial levels.
Supplelmentary report:
Deeper levels 4-15 have been cut virtually throughout the entire block. They show very similar features to that in the initial levels. There is no ulceration but there is an in-situ SSMM.
Beneath this are nests of melanocytes. They do show a slight decrease in size with depth although this is incomplete and tey do have an irregular pattern of growth in areas. Several nests of large atypical melanocytes similar to ythose in the epidermis are also noted.
It is difficult to be entirely certain whether the entire dermal component represents melanoma, although at least some of the nests of melanocytes are regarded as invasive melanoma due to their atypia. No dermal mitoses are seen
Conclusin; Severely atypical compound melanocytic lesion regarded as invasive SSMM.
Depth 0.72mm
Invasive radial growth phase
Clark level 4
No ulceration/ lymphatic, blood vessel invasion/ no perineural invasion/ no regression/ no microsatellites
Co-existent naevus uncertain
Mitotic rate (VGP only)- N/A (0 per mm squared)
TIL's (VGP) -N/A (non-brisk)
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- May 18, 2012 at 7:58 am
Thank you Janner and Natasha.
Here is the my report- I did not get a second opinion as the writer is a dermatopathologist and I have already had the WLE. SLNB is not offered in the UK for lesions under 1mm unless they are ulcerated.
This punch biopsy of skin is non-ulcerated and contains at least an in-situ SSm with a superficial dermal component showing some atypia which is indefinite for invasive melanoma on the initial levels.
Supplelmentary report:
Deeper levels 4-15 have been cut virtually throughout the entire block. They show very similar features to that in the initial levels. There is no ulceration but there is an in-situ SSMM.
Beneath this are nests of melanocytes. They do show a slight decrease in size with depth although this is incomplete and tey do have an irregular pattern of growth in areas. Several nests of large atypical melanocytes similar to ythose in the epidermis are also noted.
It is difficult to be entirely certain whether the entire dermal component represents melanoma, although at least some of the nests of melanocytes are regarded as invasive melanoma due to their atypia. No dermal mitoses are seen
Conclusin; Severely atypical compound melanocytic lesion regarded as invasive SSMM.
Depth 0.72mm
Invasive radial growth phase
Clark level 4
No ulceration/ lymphatic, blood vessel invasion/ no perineural invasion/ no regression/ no microsatellites
Co-existent naevus uncertain
Mitotic rate (VGP only)- N/A (0 per mm squared)
TIL's (VGP) -N/A (non-brisk)
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- May 18, 2012 at 7:58 am
Thank you Janner and Natasha.
Here is the my report- I did not get a second opinion as the writer is a dermatopathologist and I have already had the WLE. SLNB is not offered in the UK for lesions under 1mm unless they are ulcerated.
This punch biopsy of skin is non-ulcerated and contains at least an in-situ SSm with a superficial dermal component showing some atypia which is indefinite for invasive melanoma on the initial levels.
Supplelmentary report:
Deeper levels 4-15 have been cut virtually throughout the entire block. They show very similar features to that in the initial levels. There is no ulceration but there is an in-situ SSMM.
Beneath this are nests of melanocytes. They do show a slight decrease in size with depth although this is incomplete and tey do have an irregular pattern of growth in areas. Several nests of large atypical melanocytes similar to ythose in the epidermis are also noted.
It is difficult to be entirely certain whether the entire dermal component represents melanoma, although at least some of the nests of melanocytes are regarded as invasive melanoma due to their atypia. No dermal mitoses are seen
Conclusin; Severely atypical compound melanocytic lesion regarded as invasive SSMM.
Depth 0.72mm
Invasive radial growth phase
Clark level 4
No ulceration/ lymphatic, blood vessel invasion/ no perineural invasion/ no regression/ no microsatellites
Co-existent naevus uncertain
Mitotic rate (VGP only)- N/A (0 per mm squared)
TIL's (VGP) -N/A (non-brisk)
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- May 18, 2012 at 11:03 am
From my expierence I think secong pathology is important if you have any doubts.
I had 2 reports : first says Breslow 2mm ,clark 2 .
I decided it is very odd to have clark 2 and so deep Breslow.
Second report says : Breslow 0.2 mm Clark 2.
🙂
Second pathologist contacted first one ,who was abroad , and they found out it is typing mistake in first report and IT IS 0.2 mm instead of 2mm.
But I was already sheduled for SNB because of 2mm.
I am happy they have done second pathology and I did not have extra surgery!!!
First pathology did not say anything about radial or vertical growth phase and as I see they usually do it in England – writing phase in report ,and tis is very good I think!
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- May 18, 2012 at 11:03 am
From my expierence I think secong pathology is important if you have any doubts.
I had 2 reports : first says Breslow 2mm ,clark 2 .
I decided it is very odd to have clark 2 and so deep Breslow.
Second report says : Breslow 0.2 mm Clark 2.
🙂
Second pathologist contacted first one ,who was abroad , and they found out it is typing mistake in first report and IT IS 0.2 mm instead of 2mm.
But I was already sheduled for SNB because of 2mm.
I am happy they have done second pathology and I did not have extra surgery!!!
First pathology did not say anything about radial or vertical growth phase and as I see they usually do it in England – writing phase in report ,and tis is very good I think!
-
- May 18, 2012 at 11:03 am
From my expierence I think secong pathology is important if you have any doubts.
I had 2 reports : first says Breslow 2mm ,clark 2 .
I decided it is very odd to have clark 2 and so deep Breslow.
Second report says : Breslow 0.2 mm Clark 2.
🙂
Second pathologist contacted first one ,who was abroad , and they found out it is typing mistake in first report and IT IS 0.2 mm instead of 2mm.
But I was already sheduled for SNB because of 2mm.
I am happy they have done second pathology and I did not have extra surgery!!!
First pathology did not say anything about radial or vertical growth phase and as I see they usually do it in England – writing phase in report ,and tis is very good I think!
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- May 28, 2012 at 2:26 pm
My melanoma has been confirmed by a Specialist Dermatopathologist (one of only 50 in the UK and to whom a general histopathologist would refer for a second opinion) as being in an invasive radial growth phase even though it is Clark level 4. This is because no mitotic figures were seen in the 15 levels cut, which is more than is sampled for most lesions, and because the largest nest of cells was junctional between the epidermis and dermis rather than intradermal.
This does not in itself translate to a better prognosis as there seem to be concerns over the conclusiveness of previous research regarding invasive RGP and VGP.
I now feel even more confused over the Clark level 4 and where this fits into prognosis with thin melanomas. I'm guessing that level 4 is quite unusual in a 0.72mm depth melanoma as you read of some melanomas of much higher depth which are still Clark 4. Is it possible, therefore, that my melanoma could be of a higher risk than one of depth 1.5mm, for example, and Clark level 3 with no mitoses?
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- May 28, 2012 at 2:26 pm
My melanoma has been confirmed by a Specialist Dermatopathologist (one of only 50 in the UK and to whom a general histopathologist would refer for a second opinion) as being in an invasive radial growth phase even though it is Clark level 4. This is because no mitotic figures were seen in the 15 levels cut, which is more than is sampled for most lesions, and because the largest nest of cells was junctional between the epidermis and dermis rather than intradermal.
This does not in itself translate to a better prognosis as there seem to be concerns over the conclusiveness of previous research regarding invasive RGP and VGP.
I now feel even more confused over the Clark level 4 and where this fits into prognosis with thin melanomas. I'm guessing that level 4 is quite unusual in a 0.72mm depth melanoma as you read of some melanomas of much higher depth which are still Clark 4. Is it possible, therefore, that my melanoma could be of a higher risk than one of depth 1.5mm, for example, and Clark level 3 with no mitoses?
-
- May 28, 2012 at 2:26 pm
My melanoma has been confirmed by a Specialist Dermatopathologist (one of only 50 in the UK and to whom a general histopathologist would refer for a second opinion) as being in an invasive radial growth phase even though it is Clark level 4. This is because no mitotic figures were seen in the 15 levels cut, which is more than is sampled for most lesions, and because the largest nest of cells was junctional between the epidermis and dermis rather than intradermal.
This does not in itself translate to a better prognosis as there seem to be concerns over the conclusiveness of previous research regarding invasive RGP and VGP.
I now feel even more confused over the Clark level 4 and where this fits into prognosis with thin melanomas. I'm guessing that level 4 is quite unusual in a 0.72mm depth melanoma as you read of some melanomas of much higher depth which are still Clark 4. Is it possible, therefore, that my melanoma could be of a higher risk than one of depth 1.5mm, for example, and Clark level 3 with no mitoses?
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