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Second opinions. Are they necessary for aytipicals?

Forums General Melanoma Community Second opinions. Are they necessary for aytipicals?

  • Post
    mlbjab
    Participant

      I have been reading about so many cases of misdiagnosis.  Are second opinions required for atypical too? 

      I have been reading about so many cases of misdiagnosis.  Are second opinions required for atypical too? 

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    • Replies
        Janner
        Participant

          Was the lesion read by a dermatopathologist?  Someone who looks at melanoma a lot?  Were there clear margins?  HOW atypical was it?  There are typically degrees of atypia and that could influence my decision.

          If the lesion was mildly or moderately atypical and it had clear margins, I probably wouldn't do a re-read.  I would just watch the scar area for any pigment regrowth.  If the lesion was severely atypical and excised with the standard 5mm margins, I probably wouldn't do a re-read and here's why:  an atypical lesion is NOT cancer.  Melanoma in situ is excised with 5mm exactly the same as severely atypical lesions.   If another dermatopathologist reads it, it could be labeled melanoma in situ.  The two are "degrees" apart and one pathologist says cancer while the other thinks "not quite".  However, for your medical history, it is better never to have a melanoma diagnosis.  It affects your ability to get health and life insurance.  Some companies will never cover you with life insurance if you've had a melanoma diagnosis regardless of how deep and how long ago.  So there's a fine line to think about because that re-read may make future insurability difficult. 

          Yes, a misdiagnosis can happen – reading pathology is an art as much as a science.  But in general, most are read as correctly as you can expect with an inexact science.  So, what's your level of worry, and are you willing to risk a melanoma diagnosis?  Chances are, the re-read would be similar to your first reading, but there is always a chance that the pathologist might err on the side of caution and overdiagnose. 

          Do what makes YOU comfortable!

          Janner

          Janner
          Participant

            Was the lesion read by a dermatopathologist?  Someone who looks at melanoma a lot?  Were there clear margins?  HOW atypical was it?  There are typically degrees of atypia and that could influence my decision.

            If the lesion was mildly or moderately atypical and it had clear margins, I probably wouldn't do a re-read.  I would just watch the scar area for any pigment regrowth.  If the lesion was severely atypical and excised with the standard 5mm margins, I probably wouldn't do a re-read and here's why:  an atypical lesion is NOT cancer.  Melanoma in situ is excised with 5mm exactly the same as severely atypical lesions.   If another dermatopathologist reads it, it could be labeled melanoma in situ.  The two are "degrees" apart and one pathologist says cancer while the other thinks "not quite".  However, for your medical history, it is better never to have a melanoma diagnosis.  It affects your ability to get health and life insurance.  Some companies will never cover you with life insurance if you've had a melanoma diagnosis regardless of how deep and how long ago.  So there's a fine line to think about because that re-read may make future insurability difficult. 

            Yes, a misdiagnosis can happen – reading pathology is an art as much as a science.  But in general, most are read as correctly as you can expect with an inexact science.  So, what's your level of worry, and are you willing to risk a melanoma diagnosis?  Chances are, the re-read would be similar to your first reading, but there is always a chance that the pathologist might err on the side of caution and overdiagnose. 

            Do what makes YOU comfortable!

            Janner

              mlbjab
              Participant

                It said mild atypical and extends to margin however it said that it was a neoplasm of uknown potential based on coding??  The report is from a LabCorp and read by a general pathologist.

                mlbjab
                Participant

                  It said mild atypical and extends to margin however it said that it was a neoplasm of uknown potential based on coding??  The report is from a LabCorp and read by a general pathologist.

                  Janner
                  Participant

                    Mildly atypical lesions are basically considered benign.  So unless the guy is really off, I probably wouldn't feel a need for a second opinion.  However, I think if you really want a second opinion, you can go there.  Make sure the guy is a dermatopathologist.  They specialize in reading skin pathology.

                    Janner

                    Janner
                    Participant

                      Mildly atypical lesions are basically considered benign.  So unless the guy is really off, I probably wouldn't feel a need for a second opinion.  However, I think if you really want a second opinion, you can go there.  Make sure the guy is a dermatopathologist.  They specialize in reading skin pathology.

                      Janner

                      Janner
                      Participant

                        Mildly atypical lesions are basically considered benign.  So unless the guy is really off, I probably wouldn't feel a need for a second opinion.  However, I think if you really want a second opinion, you can go there.  Make sure the guy is a dermatopathologist.  They specialize in reading skin pathology.

                        Janner

                        mlbjab
                        Participant

                          It said mild atypical and extends to margin however it said that it was a neoplasm of uknown potential based on coding??  The report is from a LabCorp and read by a general pathologist.

                          natasha
                          Participant

                            It looks like pathologists usually giving worst scenario dianosys.

                            In my case it was even said ;; this is your diagnosys at worst''

                            But yes ,I think 2 opinions are better then 1  – just for your peace of mind.

                            I had 2 in different countries ,both said the same.

                            natasha
                            Participant

                              It looks like pathologists usually giving worst scenario dianosys.

                              In my case it was even said ;; this is your diagnosys at worst''

                              But yes ,I think 2 opinions are better then 1  – just for your peace of mind.

                              I had 2 in different countries ,both said the same.

                              green8300
                              Participant

                                i had .65 melanoma and 1 mitosis per mm,,,,,on shave biopsy,,,,on wide excision i had malignant melanoma still persistant,,,,read by another pathologist,,,,,,went for sentinel lymph biopsy and the surgeoun had his own pathology people read it before surgury just to make sure they came up with .73mm 2 mitosis per mm, and no malignant melanoma after shave biopsy so things differ a bit

                                green8300
                                Participant

                                  i had .65 melanoma and 1 mitosis per mm,,,,,on shave biopsy,,,,on wide excision i had malignant melanoma still persistant,,,,read by another pathologist,,,,,,went for sentinel lymph biopsy and the surgeoun had his own pathology people read it before surgury just to make sure they came up with .73mm 2 mitosis per mm, and no malignant melanoma after shave biopsy so things differ a bit

                                  green8300
                                  Participant

                                    i had .65 melanoma and 1 mitosis per mm,,,,,on shave biopsy,,,,on wide excision i had malignant melanoma still persistant,,,,read by another pathologist,,,,,,went for sentinel lymph biopsy and the surgeoun had his own pathology people read it before surgury just to make sure they came up with .73mm 2 mitosis per mm, and no malignant melanoma after shave biopsy so things differ a bit

                                    natasha
                                    Participant

                                      It looks like pathologists usually giving worst scenario dianosys.

                                      In my case it was even said ;; this is your diagnosys at worst''

                                      But yes ,I think 2 opinions are better then 1  – just for your peace of mind.

                                      I had 2 in different countries ,both said the same.

                                    Janner
                                    Participant

                                      Was the lesion read by a dermatopathologist?  Someone who looks at melanoma a lot?  Were there clear margins?  HOW atypical was it?  There are typically degrees of atypia and that could influence my decision.

                                      If the lesion was mildly or moderately atypical and it had clear margins, I probably wouldn't do a re-read.  I would just watch the scar area for any pigment regrowth.  If the lesion was severely atypical and excised with the standard 5mm margins, I probably wouldn't do a re-read and here's why:  an atypical lesion is NOT cancer.  Melanoma in situ is excised with 5mm exactly the same as severely atypical lesions.   If another dermatopathologist reads it, it could be labeled melanoma in situ.  The two are "degrees" apart and one pathologist says cancer while the other thinks "not quite".  However, for your medical history, it is better never to have a melanoma diagnosis.  It affects your ability to get health and life insurance.  Some companies will never cover you with life insurance if you've had a melanoma diagnosis regardless of how deep and how long ago.  So there's a fine line to think about because that re-read may make future insurability difficult. 

                                      Yes, a misdiagnosis can happen – reading pathology is an art as much as a science.  But in general, most are read as correctly as you can expect with an inexact science.  So, what's your level of worry, and are you willing to risk a melanoma diagnosis?  Chances are, the re-read would be similar to your first reading, but there is always a chance that the pathologist might err on the side of caution and overdiagnose. 

                                      Do what makes YOU comfortable!

                                      Janner

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