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PLEASE someone help me understand this Path Report!! Makes no sense

Forums Cutaneous Melanoma Community PLEASE someone help me understand this Path Report!! Makes no sense

  • Post
    Tset
    Participant

    Hi all. Im freaking out about my biopsy path report. Heres the history. 3 and a half years ago I got diagnosed with a Lentigo Maligna/ Melanoma in situ on my chest. Had a WLE done and all was well. I actually had a dew freckles as I would call them that were close to the scar and one that was really close to scar and it kind of ran over to the scar, basically half of the freckle was on the scar. It was there right after WLE and i assumed since I had alot of feckles that it just got pulled there when the did the surgery. I even took a pic of it a few days after my surgery just to show my mom the scar. Anyway, fast forward to now. Derm removed that same freckle/mole because she thought the color changed just a little. She said she wasnt at all concerned as it is likely normal pigment change. She called me today and told me the news, Recurrent Melanoma in situ. She said it was on the outer most layer of skin and the prognosis was exellent. I have yet to read anything that a recurrance is an exellent prognosis. This is what my path report says.. " In the epidermis, there is a proliferation of atypical melanocytes with occasional nests. Some of the melanocytes extend into the epithelium or hair follicles. There are also areas of fibrosis and scar. Immunohistochemical stains with appropriate controls were performed with SOX-10 and Melan-A. These stains confirm these findings. The neoplasm extends to the lateral margins and reexcision of this lesion to ensure complete removal would be judicious." This was also a deep shave biopsy. I told my derm about this freckle that it was there right after surgery but she doesnt remember seeing it. I have a pic but couldnt find it while in her office and only found it after I left. She said a rogue cancer cell wouldnt grow out of an existing freckle there. She thought this was a new spot from a year or so ago. She never took a pic after my first WLE 3 and a half years ago. What does this mean? Is this from rogue cells that just caused another melanoma in situ? I thought if it was local recurrence that it wouldnt be in situ. It starts making me questons other things like a few years ago i noticed a lump on the outter part of breast. showed my derm who said it was in breast tissue and I should check it out with gyno. Did that and she had me get a mammogram adn ultra sound. mammogram was negative and ultrasound said 2 small intramammary reactive lymph nodes were noted and no follow up neccessary. Then about 5 months ago I noticed a small lump middle way down my quad. Had my derm and GP look at it and both said nothing to worry about, derm said it was small, moveable and felt like a cyst. And now this so it has me freaking out. I was 34 when I first had a meanoma in situ and im now 38. Sorry for the long post.  TSET

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      Janner
      Participant
      Lentigo Maligna has the highest local recurrence rate of any type of melanoma. This really changes nothing. LM is typically slow growing so this could be something left behind from your original lesion. You just need to have the re-excision. Nothing changes in prognosis or staging. Bump in the road. Nothing on your quad would be related to this. Always good to be vigilant and taking pictures is great method of watching for change. I have freckles growing through some of my scars so a good reminder to watch for change. Get over the shock and return to living life!

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        Tset
        Participant

        Janner, thank you so for your kind words. I thought melanoma in situ couldnt be a recurrance as It would grow from the inside out. It seems odd that I have had this freckle there from a few days after my origional WLE. Maybe it just started growing in there. Do you think I should have a SLNB before I get this excised even though im insitu? If This was melanoma in the two nodes on the side of left breast wouldnt the nodes be increasing in size?

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        Janner
        Participant

        In situ means it is confined to the epidermis, and there aren't any lymph or blood vessels in the epidermis.  If the original excision didn't get every cell, those cells could continue to grow and multiply.  It could be that the freckle was there but a little melanoma was left too and grew coincidentally into the same area.  I, personally, see no need to do the SLNB when something is in situ.   As I said before, this is not that uncommon in LM.   It's often hard to get the required margins.  I might ask for even larger margins this time if you think you have enough tissue to do that – just in case.  In situ usually has 5mm margins, but there are studies that say that 9mm is a better number.  If they see nothing in the deeper tissue, I don't see how anything would make it to the lymph nodes, and yes – over time, they would grow in size.  Just my take, you have to do what makes you comfortable.

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        Tset
        Participant

        That makes sense. My derm refered me to a MOHS surgeon and said that may be the way to go since this is on a scar. It is right in the middle of my chest and the scar looks like I had heart surgery, lol. Im not at all concerned about this leaving a worse scar, I just want to make sure this crap is out of my body.

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        Tset
        Participant

        I went back and looked at pics and it wasn’t there a few weeks after my first wide local excision. I saw it in a photo that was taken 1 year later and it was there. That thing has been growing for at least 2 and a half years. The more I thought about it the more it freaked me out. Here’s one thing I forgot to mention and I wanted to ask your opinion on this and whether you have ever heard of this. 6 months ago I had my skin check. I noticed a tiny little black dot on this same freckle/mole. I was scared thinking was melanoma but the derm checked it out and said it was not that it was a plugged hair follicle. She used a little stick like thing and just popped it right out. The dot was gone and I thought all was well. Now this is the same freckle/mole that was on my scar and that she removed because it was getting a little darker( not that I could tell anyway).  The path report that I wrote above mentioned something about cells in the hair follicle but it was diagnosed as a recurrent melanoma in Situ. Now I’ve just freaked myself out thinking about it. Could that have been melanoma she popped out thinking that was a plugged follicle, is that even possible to do with melanoma, wasn’t sure if it would just pop out? Now I’m rethinking everything. Sorry for the long reply. TSET

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        Janner
        Participant

        Dead cells are in hair follicles – think blackheads.  Melanoma are live cells growing and part of the skin.  They aren't going to "pop out".  Just get the re-excision and stop over analyzing this stuff.  The diagnosis was in situ and nothing else in the report changes that.  You have to go with the expert's diagnosis – not your own interpretation.

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        Tset
        Participant

        Your right Janner. Thank you :)

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