› Forums › General Melanoma Community › Question from a Newly Diagnosed?
- This topic has 6 replies, 2 voices, and was last updated 12 years, 9 months ago by
Janner.
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- July 5, 2011 at 9:20 pm
Hi all! Just got the results back from a shave biopsy. They are .6, clarks II/III nodular melanoma. I got a copy of the pathology report and there is no description of the margins. None whatsoever. No lateral or vertical margins mentioned. I'm scheduled for a WLE tomorrow and I am not sure how I feel about doing this yet. How can I be confident in the .6mm without knowing that the margins are clear? I hear these shave biopsies can be innaccurate. Any advice? Thanks…
Hi all! Just got the results back from a shave biopsy. They are .6, clarks II/III nodular melanoma. I got a copy of the pathology report and there is no description of the margins. None whatsoever. No lateral or vertical margins mentioned. I'm scheduled for a WLE tomorrow and I am not sure how I feel about doing this yet. How can I be confident in the .6mm without knowing that the margins are clear? I hear these shave biopsies can be innaccurate. Any advice? Thanks…
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- July 5, 2011 at 9:29 pm
Shave biopsies are not inaccurate. However, they can bisect a lesion so the true depth is not known. That's why you need to know if the deep margin was clear or not. I would definitely make a phone call asking about the margins – I'd want clarification. Call the doctor or the pathologist. If the lesion were bisected (i.e. deep margin not clear), I'd be thinking about the possibility of getting a SNB which MUST BE DONE PRIOR to the WLE. If the deep margin was not clear, you are left knowing your lesion is "at least .6mm deep" but nothing more. In general, the cutoff for the SNB is typically 1mm so you are well under that if the deep margin is clear. Before you agree to the WLE, get clarification on the margins. A SNB done after the WLE is truly compromised. As it stands now, you don't need the SNB if the depth is accurate. But determining the accuracy of the depth is key here. If you post your entire report, we can help you interpret all the important bits.
Best wishes,
Janner
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- July 5, 2011 at 10:42 pm
Report:
Diagnosis: Melanoma, non ulcerated, Nodular Type, Clarks Level II/III, Breslow thickness 0.6mm (172.7)
Microscopic description
sections show a proliferation of atypical epithelioid melanocytes arrayed along the dermoepidermal junctions as single cells and regular/irregular sized/shaped nests with pagetoid migration evident. Nests of similar appearing cells are present in the subajacent dermis. There is chronic inflammation in the superficial dermis. No mitotic figures are apparent in the dermal component.
That's it. No discussion of margins. I have since read that it is not mandatory to include info on margins, but I have also read that residual cancer findings in the WLE can result in upstaging of the tumor. If my entire treatment protocol rests on this thickness, it would seem an important component of the path report! Seems a little lacking, in my humble, but frightened opinion.
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- July 5, 2011 at 11:24 pm
Interesting. And the diagnosis said "nodular melanoma"? I would say it is unusual to have nodular melanoma with 0 mitosis. However, 0 mitosis is what you want to see. In this situation, I think that if the margins had not been clear, they would have been noted. Sometimes reports only include the things they see, and a transected margin would be something you see. I would still ask for clarification when you see your doctor, but in general this appears to be a low risk lesion. Sometimes a more detailed report might be sent to your doctor. I'd ask for as much information as you can get.
If the margins are clear in the biopsy, it's also rare to find more melanoma in the WLE. In general, it's hard to upstage someone after the biopsy is done based on the WLE alone because the biopsy tissue can't be "reconnected" with the WLE tissue. You can't reconstruct a depth of a lesion that was transected. You can only say the depth was "at least" what you see in the biopsy and that's about it. Upstaging can be done with a positive SNB, but in general the biopsy depth is your initial staging depth. With you, that appears to be stage IA. No diagnosis is good, but stage IA has a great prognosis.
Good luck on the WLE.
Janner
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- July 5, 2011 at 11:24 pm
Interesting. And the diagnosis said "nodular melanoma"? I would say it is unusual to have nodular melanoma with 0 mitosis. However, 0 mitosis is what you want to see. In this situation, I think that if the margins had not been clear, they would have been noted. Sometimes reports only include the things they see, and a transected margin would be something you see. I would still ask for clarification when you see your doctor, but in general this appears to be a low risk lesion. Sometimes a more detailed report might be sent to your doctor. I'd ask for as much information as you can get.
If the margins are clear in the biopsy, it's also rare to find more melanoma in the WLE. In general, it's hard to upstage someone after the biopsy is done based on the WLE alone because the biopsy tissue can't be "reconnected" with the WLE tissue. You can't reconstruct a depth of a lesion that was transected. You can only say the depth was "at least" what you see in the biopsy and that's about it. Upstaging can be done with a positive SNB, but in general the biopsy depth is your initial staging depth. With you, that appears to be stage IA. No diagnosis is good, but stage IA has a great prognosis.
Good luck on the WLE.
Janner
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- July 5, 2011 at 10:42 pm
Report:
Diagnosis: Melanoma, non ulcerated, Nodular Type, Clarks Level II/III, Breslow thickness 0.6mm (172.7)
Microscopic description
sections show a proliferation of atypical epithelioid melanocytes arrayed along the dermoepidermal junctions as single cells and regular/irregular sized/shaped nests with pagetoid migration evident. Nests of similar appearing cells are present in the subajacent dermis. There is chronic inflammation in the superficial dermis. No mitotic figures are apparent in the dermal component.
That's it. No discussion of margins. I have since read that it is not mandatory to include info on margins, but I have also read that residual cancer findings in the WLE can result in upstaging of the tumor. If my entire treatment protocol rests on this thickness, it would seem an important component of the path report! Seems a little lacking, in my humble, but frightened opinion.
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- July 5, 2011 at 9:29 pm
Shave biopsies are not inaccurate. However, they can bisect a lesion so the true depth is not known. That's why you need to know if the deep margin was clear or not. I would definitely make a phone call asking about the margins – I'd want clarification. Call the doctor or the pathologist. If the lesion were bisected (i.e. deep margin not clear), I'd be thinking about the possibility of getting a SNB which MUST BE DONE PRIOR to the WLE. If the deep margin was not clear, you are left knowing your lesion is "at least .6mm deep" but nothing more. In general, the cutoff for the SNB is typically 1mm so you are well under that if the deep margin is clear. Before you agree to the WLE, get clarification on the margins. A SNB done after the WLE is truly compromised. As it stands now, you don't need the SNB if the depth is accurate. But determining the accuracy of the depth is key here. If you post your entire report, we can help you interpret all the important bits.
Best wishes,
Janner
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Tagged: cutaneous melanoma
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