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- This topic has 38 replies, 5 voices, and was last updated 12 years, 10 months ago by
CAdesiree.
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- June 2, 2011 at 11:45 pm
i was recently diagnosed w melanoma. there were 2 biopsies. one came back "malignant melanoma in situ," and the other came back "malignant melanoma of superficial spreading type, invasive to a breslows depth of 0.72mm, clarks level 3." but the biopsies were from the same lesion, just different portions of it. and i cant get anyone to answer if its possible the depth could be increased in the location mole originated. im just trying to understand how this disease acts.
i was recently diagnosed w melanoma. there were 2 biopsies. one came back "malignant melanoma in situ," and the other came back "malignant melanoma of superficial spreading type, invasive to a breslows depth of 0.72mm, clarks level 3." but the biopsies were from the same lesion, just different portions of it. and i cant get anyone to answer if its possible the depth could be increased in the location mole originated. im just trying to understand how this disease acts. so far ive been told the same lesion shouldnt have come back w different pathologies, but it did. any help is appreciated…
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- June 3, 2011 at 12:40 am
I don't think it's unusual to have two different depths. Melanoma lesions start out as in situ – confined to the epidermis. Then they start spreading downward. So your two biopsies (why did they do 2?) caught part of the lesion still in its earliest phase and another portion in its vertical growth phase. Not really unusual at all. While not all lesions grow like this, think of the edges as having the melanoma in situ, and the center portion growing downward and more mature. The center section is invasive, and the edges are still growing on the surface only.
The unusual bit is having two biopsies. Did they do them at the same time? Different times? Was one part of the WLE (wide local excision) where they took larger margins? I guess I'm just a bit confused as to why you had two biopsies, but the rest makes reasonable sense to me.
As for your question "if its possible the depth could be increased in the location mole originated", I guess I'm not sure what you are asking. Do you have copies of the pathology reports? Was the deep margin clear? If the deep margin was not clear, it could be possible that the lesion was deeper. However, I'm not sure I'm correctly interpreting your question. If you could post your pathology reports so we could read them, we could be of more help.
Best wishes,
Janner
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- June 3, 2011 at 12:57 am
i really appreciate your response. they took 2 punch biopsies on the same day, from the same lesion. one, was the "center" of the lesion according to them. the other, was from the border. my concern is the one they considered "center" is not actually where the lesion originated. so if they were to check depth on the location lesion originated is it possible it went even deeper, therefor being a different stage? or is that not how it works? is that a little clearer?
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- June 3, 2011 at 1:09 am
It is possible there is a portion of the melanoma left behind that is deeper? Yes. Probably not likely but certainly possible. How large is this lesion that they took two punches? In general, melanoma would most likely grow deepest at the center of the lesion, but it's not a guarantee.
The key is to have the WLE to get margins. Then they can analyze the rest of the lesion and will give you a "final" depth if something is actually deeper than the .70mm.
Best wishes,
Janner
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- June 3, 2011 at 1:09 am
It is possible there is a portion of the melanoma left behind that is deeper? Yes. Probably not likely but certainly possible. How large is this lesion that they took two punches? In general, melanoma would most likely grow deepest at the center of the lesion, but it's not a guarantee.
The key is to have the WLE to get margins. Then they can analyze the rest of the lesion and will give you a "final" depth if something is actually deeper than the .70mm.
Best wishes,
Janner
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- June 3, 2011 at 12:57 am
i really appreciate your response. they took 2 punch biopsies on the same day, from the same lesion. one, was the "center" of the lesion according to them. the other, was from the border. my concern is the one they considered "center" is not actually where the lesion originated. so if they were to check depth on the location lesion originated is it possible it went even deeper, therefor being a different stage? or is that not how it works? is that a little clearer?
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- June 3, 2011 at 12:40 am
I don't think it's unusual to have two different depths. Melanoma lesions start out as in situ – confined to the epidermis. Then they start spreading downward. So your two biopsies (why did they do 2?) caught part of the lesion still in its earliest phase and another portion in its vertical growth phase. Not really unusual at all. While not all lesions grow like this, think of the edges as having the melanoma in situ, and the center portion growing downward and more mature. The center section is invasive, and the edges are still growing on the surface only.
The unusual bit is having two biopsies. Did they do them at the same time? Different times? Was one part of the WLE (wide local excision) where they took larger margins? I guess I'm just a bit confused as to why you had two biopsies, but the rest makes reasonable sense to me.
As for your question "if its possible the depth could be increased in the location mole originated", I guess I'm not sure what you are asking. Do you have copies of the pathology reports? Was the deep margin clear? If the deep margin was not clear, it could be possible that the lesion was deeper. However, I'm not sure I'm correctly interpreting your question. If you could post your pathology reports so we could read them, we could be of more help.
Best wishes,
Janner
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- June 3, 2011 at 11:30 am
I recall it being mentioned on this board a few times about part of a lesion being insitu and another part having a depth, so that is definitely possible.
I also do not understand why two biopsies were taken? Was this a GP-general practitioner or a dermatologist? I am not sure I would be comfortable with this doctor or derm.
As for your depth question, you need to look at your pathology report. In relation to your Breslow depth, if the depth portion of the tumor was transected, the pathology would say something like-depth is at least so and so-or transected, or something of that nature.
Best wishes,
Michael 1b
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- June 3, 2011 at 11:30 am
I recall it being mentioned on this board a few times about part of a lesion being insitu and another part having a depth, so that is definitely possible.
I also do not understand why two biopsies were taken? Was this a GP-general practitioner or a dermatologist? I am not sure I would be comfortable with this doctor or derm.
As for your depth question, you need to look at your pathology report. In relation to your Breslow depth, if the depth portion of the tumor was transected, the pathology would say something like-depth is at least so and so-or transected, or something of that nature.
Best wishes,
Michael 1b
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- June 3, 2011 at 2:55 pm
thanks michael & janner. i really appreciate the answers. it was a derm who did this. i was already going to seek another opinion bc he wont answer my questions. he thought it was ok to tell me i have melanoma, but not answer questions. unfortunately i go back to him this afternoon to reconstruct the mohs site. after that i will be looking for a good derm in san diego. when i find the new derm i should get my records to find out if he tested what he removed. but right now he is saying there is no reason to check depth bc it has been removed. doesnt make me feel any better… and to top it off he said i have other lesions to be concerned with, but he wont say how concerned i should be… and he is telling me to determine how aggressive we pursue this without giving me enough info to decide.
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- June 3, 2011 at 3:29 pm
Like Jan, I'm also a little confused about your details.. now I see the word MOHS being used, and that's yet another procedure from the ones you descibed.
It doesn't sound like you've had a Wide Excision yet either, which is most likey necessary.
In my opinion, even though you're lesion(s) seem shallow, you might want to ask for a referral to an Onocological Surgeon.someone with some good melanoma experience, to do the wide excision. And definately find a new dermatologist if you have other moles that need to be followed. Without making any judgement on your current doctor, the fact that you are having difficulty communicating is a pretty big deal in my book
For me, it's almost the MOST important thing..not necessarily how much melanoma experience a doc has, as how well you are able to discuss things with that doctor. It's essential to be able to ask questions and have them answered, and it's important to have a doctor who takes all of your concerns seriously.
I know it's terrifying to get a cancer diagnosis. It sounds like this is a pretty early catch, so it's likely you won't have more problems, but that doesn't really help ease the sinking feeling in the pit of your stomach knowing you now have a disease that has the potential to kill you some day!
Without insulting any of the hard working doctors out there who have worked so hard to get where they are (my son is a med student) I want to say, loudly and clearly, to anyone reading, that YOU as the patient, need to be the GENERAL of your forces. Your doctor, or doctors, are part of your medical team. they are smart and often they will know a lot more than you, but no one is ever going to be as motivated as YOU are to make sure you are getting the right kind of treatment.
Doctors see too many patients. And, it's not that they get complacent so much as it is that they are always expecting the horse.. that old saying, 'if you hear hoofbeats, think horses, not zebras' Well..that's true, and it will probably help the MOST people to think that way, so it's fine for the docs. But you are going to be the one that knows your own body..so you have to be on the lookout for zebras..and antelopes..camels…
I've got a 26 yr history with melanoma that's been very unpredicatable and has whacked my docs upside the head like a jack in the box with a bat many times.
Find a doctor you can trust, talk to, and who will listen to your concerns and instincts. I've been right about my melanoma more times than either my scans or my doctors have been.
Good luck. and I hope you'll come back and let us know how it all works out. This place here is full of people who understand exactly how you feel.
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- June 3, 2011 at 7:40 pm
thanks for your help… yes the derm decided to do MOHS after the punch biopsies came back malignant melanoma. so i had mohs on the 31st of may, and i go back today to reconstruct. ive been told MOHS is for areas of cosmetic concern… my derm didnt care when i told him im not worried about cosmetics on my back… i think he likes the more money from my insurance for the procedure… then again i already have a low opinion of him. i will be following up w a new derm or possibly oncologist… someone that addresses my concerns instead of dismissing them… thanks again.
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- June 3, 2011 at 7:40 pm
thanks for your help… yes the derm decided to do MOHS after the punch biopsies came back malignant melanoma. so i had mohs on the 31st of may, and i go back today to reconstruct. ive been told MOHS is for areas of cosmetic concern… my derm didnt care when i told him im not worried about cosmetics on my back… i think he likes the more money from my insurance for the procedure… then again i already have a low opinion of him. i will be following up w a new derm or possibly oncologist… someone that addresses my concerns instead of dismissing them… thanks again.
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- June 3, 2011 at 3:29 pm
Like Jan, I'm also a little confused about your details.. now I see the word MOHS being used, and that's yet another procedure from the ones you descibed.
It doesn't sound like you've had a Wide Excision yet either, which is most likey necessary.
In my opinion, even though you're lesion(s) seem shallow, you might want to ask for a referral to an Onocological Surgeon.someone with some good melanoma experience, to do the wide excision. And definately find a new dermatologist if you have other moles that need to be followed. Without making any judgement on your current doctor, the fact that you are having difficulty communicating is a pretty big deal in my book
For me, it's almost the MOST important thing..not necessarily how much melanoma experience a doc has, as how well you are able to discuss things with that doctor. It's essential to be able to ask questions and have them answered, and it's important to have a doctor who takes all of your concerns seriously.
I know it's terrifying to get a cancer diagnosis. It sounds like this is a pretty early catch, so it's likely you won't have more problems, but that doesn't really help ease the sinking feeling in the pit of your stomach knowing you now have a disease that has the potential to kill you some day!
Without insulting any of the hard working doctors out there who have worked so hard to get where they are (my son is a med student) I want to say, loudly and clearly, to anyone reading, that YOU as the patient, need to be the GENERAL of your forces. Your doctor, or doctors, are part of your medical team. they are smart and often they will know a lot more than you, but no one is ever going to be as motivated as YOU are to make sure you are getting the right kind of treatment.
Doctors see too many patients. And, it's not that they get complacent so much as it is that they are always expecting the horse.. that old saying, 'if you hear hoofbeats, think horses, not zebras' Well..that's true, and it will probably help the MOST people to think that way, so it's fine for the docs. But you are going to be the one that knows your own body..so you have to be on the lookout for zebras..and antelopes..camels…
I've got a 26 yr history with melanoma that's been very unpredicatable and has whacked my docs upside the head like a jack in the box with a bat many times.
Find a doctor you can trust, talk to, and who will listen to your concerns and instincts. I've been right about my melanoma more times than either my scans or my doctors have been.
Good luck. and I hope you'll come back and let us know how it all works out. This place here is full of people who understand exactly how you feel.
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- June 3, 2011 at 3:40 pm
I am still not sure I follow this. So two punch biopsies were performed, and MOHS was performed instead of a WLE or wide local excision?
Where is the location of your melanoma? I have also only heard of MOHS being done on thin melanomas.
Also, the derm is wrong. Depth is the most important factor in a melanoma diagnosis. Can you get a copy of your pathology report and post it here. By HIPPA law in the U.S, a doctor has 30 days to provide medical information to you when requested after signing a release. Many will just give it to you while you wait or may fax it.
Yes, I would get another opinion/derm.
Keep us posted,
Michael
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- June 3, 2011 at 7:50 pm
sorry im confusing… but lack of sleep will do that. my melanoma was located on my left upper back/shoulder blade. after the 2 punch biopsies came back malignant melanoma the derm performed MOHS. that procedure was from 8:30am to 1:30pm… coming back 3 times for more pieces. i had questions that were ignored. and the more questions i came up w because he left me w more melanoma pamphlets continued to go ignored. today i go back for reconstruction on the site. after that i will be looking for a new derm to follow up with. this derm says i have other lesions to be concerned with and biopsied, but is unwilling to discuss a plan of action on when & how. hoping the next derm is more communicative.
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- June 3, 2011 at 8:53 pm
You are correct MOHS is only supposed to be for areas of cosmetic concern such as the face (eyelids, nose, lips etc.), and other than Basal or squamous, I have only heard of it being done on thin melanoma (Breslow) depths or melanoma insitu (in place melanoma which has no depth). MOHS should NOT have been done on your shoulder blade. My upper left back/shoulder blade is where my second melanoma was located, and it had a Breslow of .30 mm, not ulcerated, one mitosis. I had a WLE performed on the area with no difficulty whatsoever.
I think this derm is padding his paycheck.
Michael
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- June 3, 2011 at 8:53 pm
You are correct MOHS is only supposed to be for areas of cosmetic concern such as the face (eyelids, nose, lips etc.), and other than Basal or squamous, I have only heard of it being done on thin melanoma (Breslow) depths or melanoma insitu (in place melanoma which has no depth). MOHS should NOT have been done on your shoulder blade. My upper left back/shoulder blade is where my second melanoma was located, and it had a Breslow of .30 mm, not ulcerated, one mitosis. I had a WLE performed on the area with no difficulty whatsoever.
I think this derm is padding his paycheck.
Michael
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- June 3, 2011 at 9:05 pm
The more I think about this, the more this steams me up!
Get your medical file and go to another doctor. Get a second opinion on the MOHS surgery and your slides to verify you have clear margins. Also discuss if a WLE may still be needed to make sure you have clear margins.
Also, post your path report here when you get it and someone will assist you further. Since you already had MOHS, knowing the Breslow depth and if all margins (lateral and depth) are clear is very important.
Michael
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- June 4, 2011 at 1:48 am
i couldnt agree more… i see my primary on the 8th and will get another referal to a new derm. this derm did the reconstruct today, the nurse says the scar will be the length of a pen… really makes me wonder what the scar would have been without the cosmetic procedure… either way im glad i only need to return to him for suture removal. i will keep you all posted. and when i get a chance i will post the pathology i have for the initial biopsies. i dont have any paperwork for the MOHS, so all i have was his word that he got it all. im just hoping it will be in my file when i transfer doctors.
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- June 4, 2011 at 1:48 am
i couldnt agree more… i see my primary on the 8th and will get another referal to a new derm. this derm did the reconstruct today, the nurse says the scar will be the length of a pen… really makes me wonder what the scar would have been without the cosmetic procedure… either way im glad i only need to return to him for suture removal. i will keep you all posted. and when i get a chance i will post the pathology i have for the initial biopsies. i dont have any paperwork for the MOHS, so all i have was his word that he got it all. im just hoping it will be in my file when i transfer doctors.
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- June 3, 2011 at 9:05 pm
The more I think about this, the more this steams me up!
Get your medical file and go to another doctor. Get a second opinion on the MOHS surgery and your slides to verify you have clear margins. Also discuss if a WLE may still be needed to make sure you have clear margins.
Also, post your path report here when you get it and someone will assist you further. Since you already had MOHS, knowing the Breslow depth and if all margins (lateral and depth) are clear is very important.
Michael
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- June 3, 2011 at 7:50 pm
sorry im confusing… but lack of sleep will do that. my melanoma was located on my left upper back/shoulder blade. after the 2 punch biopsies came back malignant melanoma the derm performed MOHS. that procedure was from 8:30am to 1:30pm… coming back 3 times for more pieces. i had questions that were ignored. and the more questions i came up w because he left me w more melanoma pamphlets continued to go ignored. today i go back for reconstruction on the site. after that i will be looking for a new derm to follow up with. this derm says i have other lesions to be concerned with and biopsied, but is unwilling to discuss a plan of action on when & how. hoping the next derm is more communicative.
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- June 3, 2011 at 3:40 pm
I am still not sure I follow this. So two punch biopsies were performed, and MOHS was performed instead of a WLE or wide local excision?
Where is the location of your melanoma? I have also only heard of MOHS being done on thin melanomas.
Also, the derm is wrong. Depth is the most important factor in a melanoma diagnosis. Can you get a copy of your pathology report and post it here. By HIPPA law in the U.S, a doctor has 30 days to provide medical information to you when requested after signing a release. Many will just give it to you while you wait or may fax it.
Yes, I would get another opinion/derm.
Keep us posted,
Michael
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- June 3, 2011 at 4:38 pm
I'm seeing red flags. Mohs isn't typically done for melanoma unless maybe it is on the face. My cutaneous oncologist and Mohs surgeon only does it for Lentigo Maligna (in situ) because it has a high local recurrence rate. Normal removal with parafin and staining is the best way to analyze melanoma – not Mohs. This is the WLE (wide local excision) that I mentioned earlier. It is the standard and recommended way to check for margins on melanoma. Mohs is truly better suited for Basal Cell or Squamous Cell Carcinoma.
It is likely you have the depth correct, but it isn't absolute. Punch biopsies get the depth of the lesion so it's not that the lesion was transected. Even if he didn't get dead center with the punch, the likelihood of the lesion depth being significantly different is probably unlikely.
I'd get copies of the pathology report TODAY. Check that it is read by a dermatopathologist. Write down all your questions and hand him a copy. Don't leave until he answers them.
Oh, have any of your other "suspicious lesions" changed? It's not too common to have more than one melanoma – only about 8% of the melanoma population do. So I wouldn't be worrying too much about the other moles at this point. Just watch things for CHANGE. Changing moles are the ones that need to be biopsied.
I agree with Dian – communication is the most important thing. You need someone who you can work WITH, otherwise you'll just be frustrated all the time.
Best wishes,
Janner
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- June 3, 2011 at 7:56 pm
i will be ready with an army of questions for the next derm. from this one i will be reconstructed today. and unfortunately the other "lesions" have changed… but i will discuss with a new derm a plan of action. communication is HUGE, and this guy admits its not his strong suit. so lets hope the next derm is better at communicating. thank you all again…
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- June 3, 2011 at 7:56 pm
i will be ready with an army of questions for the next derm. from this one i will be reconstructed today. and unfortunately the other "lesions" have changed… but i will discuss with a new derm a plan of action. communication is HUGE, and this guy admits its not his strong suit. so lets hope the next derm is better at communicating. thank you all again…
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- June 3, 2011 at 4:38 pm
I'm seeing red flags. Mohs isn't typically done for melanoma unless maybe it is on the face. My cutaneous oncologist and Mohs surgeon only does it for Lentigo Maligna (in situ) because it has a high local recurrence rate. Normal removal with parafin and staining is the best way to analyze melanoma – not Mohs. This is the WLE (wide local excision) that I mentioned earlier. It is the standard and recommended way to check for margins on melanoma. Mohs is truly better suited for Basal Cell or Squamous Cell Carcinoma.
It is likely you have the depth correct, but it isn't absolute. Punch biopsies get the depth of the lesion so it's not that the lesion was transected. Even if he didn't get dead center with the punch, the likelihood of the lesion depth being significantly different is probably unlikely.
I'd get copies of the pathology report TODAY. Check that it is read by a dermatopathologist. Write down all your questions and hand him a copy. Don't leave until he answers them.
Oh, have any of your other "suspicious lesions" changed? It's not too common to have more than one melanoma – only about 8% of the melanoma population do. So I wouldn't be worrying too much about the other moles at this point. Just watch things for CHANGE. Changing moles are the ones that need to be biopsied.
I agree with Dian – communication is the most important thing. You need someone who you can work WITH, otherwise you'll just be frustrated all the time.
Best wishes,
Janner
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- June 3, 2011 at 2:55 pm
thanks michael & janner. i really appreciate the answers. it was a derm who did this. i was already going to seek another opinion bc he wont answer my questions. he thought it was ok to tell me i have melanoma, but not answer questions. unfortunately i go back to him this afternoon to reconstruct the mohs site. after that i will be looking for a good derm in san diego. when i find the new derm i should get my records to find out if he tested what he removed. but right now he is saying there is no reason to check depth bc it has been removed. doesnt make me feel any better… and to top it off he said i have other lesions to be concerned with, but he wont say how concerned i should be… and he is telling me to determine how aggressive we pursue this without giving me enough info to decide.
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- June 4, 2011 at 2:48 pm
I think reading all of the posts, one thing is obvious…you have "malignant melanoma of superficial spreading type…" and you need treatment ASAP.
Back in 1991 I was had a oblong freckle and diagnosed with lentigo maligna. I was told it was precancerous…they removed every mole on my body and only the freckle came back precancerous…told nothing to worry about…they got it all. It began to grow again back in 1996 and I was busy and didn't address it…after all it was just a spot…
In 2000 when my little purple bump was removed for the second time from my neck, it was: .Diagnosis: Malignant Melanoma. Clark's Level 3. Tumor Thickness 1.45mm. The Margins of Excision appear uninvolved. " Had 5 sentinel lymph nodes removed…and they were all clear….told nothing to worry about…no follow up, no treatment…no nothing…no worries….
Began having alot of odd symptoms…always exhausted, trouble breathing and a small dry cough…mostly at night…after a EKG and Chest x ray my world changed. A mass was growing and beginning cutting off blood supply to the upper half of my body…I was dying and didn't know it. The mass was growing beside the superior vena cava ,,,
June 18, 2009 biopsy was done at Mayo and I was stage 4 they found "an obvious very enlarged black right paratracheal lymph node" but couldn't remove it because of it's location to heart, lungs and all those famously important vessels…they said it was too dangerous…
It wasn't until March 26, 2010 after radiation, chemo etc etc that they agreed to do the surgery I begged for, I mean after all…they gave me 6-9 months at best and here I was still standing…
Now it's June 4, 2011 and I am NED…thanks to Dr Weber's trial I am hoping to remain NED with a lot of blessings and some advancement in immunotherapy. I am trying to be cautiously optimistic!.
Find a melanoma specialist ASAP…not a dermatologist or plastic surgeon ( although they gave me better scars than regular surgeons!) and not a regular oncologist…find one who deals exclusively with cutaneous skin cancers and specifically melanoma! Blessings- Lynn
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- June 4, 2011 at 5:26 pm
what is NED? and how would i find a melanoma specialist? i have been having trouble finding another derm. the list my insurance gave me is mostly pediatric, and the ones that take adults no longer take my insurance. i meet with my primary on the 8th and will ask for new referal. i will also post pathology for biopsies when i can sit & type longer. right now im pretty sore. i really appreciate everyones advice & help.
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- June 4, 2011 at 5:26 pm
what is NED? and how would i find a melanoma specialist? i have been having trouble finding another derm. the list my insurance gave me is mostly pediatric, and the ones that take adults no longer take my insurance. i meet with my primary on the 8th and will ask for new referal. i will also post pathology for biopsies when i can sit & type longer. right now im pretty sore. i really appreciate everyones advice & help.
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- June 4, 2011 at 2:48 pm
I think reading all of the posts, one thing is obvious…you have "malignant melanoma of superficial spreading type…" and you need treatment ASAP.
Back in 1991 I was had a oblong freckle and diagnosed with lentigo maligna. I was told it was precancerous…they removed every mole on my body and only the freckle came back precancerous…told nothing to worry about…they got it all. It began to grow again back in 1996 and I was busy and didn't address it…after all it was just a spot…
In 2000 when my little purple bump was removed for the second time from my neck, it was: .Diagnosis: Malignant Melanoma. Clark's Level 3. Tumor Thickness 1.45mm. The Margins of Excision appear uninvolved. " Had 5 sentinel lymph nodes removed…and they were all clear….told nothing to worry about…no follow up, no treatment…no nothing…no worries….
Began having alot of odd symptoms…always exhausted, trouble breathing and a small dry cough…mostly at night…after a EKG and Chest x ray my world changed. A mass was growing and beginning cutting off blood supply to the upper half of my body…I was dying and didn't know it. The mass was growing beside the superior vena cava ,,,
June 18, 2009 biopsy was done at Mayo and I was stage 4 they found "an obvious very enlarged black right paratracheal lymph node" but couldn't remove it because of it's location to heart, lungs and all those famously important vessels…they said it was too dangerous…
It wasn't until March 26, 2010 after radiation, chemo etc etc that they agreed to do the surgery I begged for, I mean after all…they gave me 6-9 months at best and here I was still standing…
Now it's June 4, 2011 and I am NED…thanks to Dr Weber's trial I am hoping to remain NED with a lot of blessings and some advancement in immunotherapy. I am trying to be cautiously optimistic!.
Find a melanoma specialist ASAP…not a dermatologist or plastic surgeon ( although they gave me better scars than regular surgeons!) and not a regular oncologist…find one who deals exclusively with cutaneous skin cancers and specifically melanoma! Blessings- Lynn
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- June 12, 2011 at 4:25 pm
sorry this took so long… didnt realize how much movement my left shoulder was involved in until they stitched it for reconstruction… i go back to the original derm on the 17th to remove stitches. but i am waiting on my insurance to get a second opinion from a melanoma specialist. both the specialist & my primary are trying to expedite w the insurance company. i dont have a scanner so i will type the pathology from the original biopsies.
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).
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- June 12, 2011 at 4:25 pm
sorry this took so long… didnt realize how much movement my left shoulder was involved in until they stitched it for reconstruction… i go back to the original derm on the 17th to remove stitches. but i am waiting on my insurance to get a second opinion from a melanoma specialist. both the specialist & my primary are trying to expedite w the insurance company. i dont have a scanner so i will type the pathology from the original biopsies.
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).
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Tagged: cutaneous melanoma
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