The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Content within the patient forum is user-generated and has not been reviewed by medical professionals. Other sections of the Melanoma Research Foundation website include information that has been reviewed by medical professionals as appropriate. All medical decisions should be made in consultation with your doctor or other qualified medical professional.

Ulceration? Unprofessional Path report

Forums General Melanoma Community Ulceration? Unprofessional Path report

  • Post
    losborne00
    Participant

      Hi Y'all,

      Hi Y'all,

      I'm new here and looking for some information on what "melanoma ulceration" is. I had a melanoma that developed under a toe nail and was diagnosed 2 years ago (although the lesion had been there about 6 years).Sub ungal acral lentiginous melanoma was the official diagnoses. The first biopsy was a 2mm punch that described no ulceration present. After my toe was removed at a leading hospital in the southeast, I got a copy of their path report and it seemed to be lacking recommended diagnostic measurements. The pathologist was presented the entire toe to examine. The path report lacked important info. No mitotic rate, lymphocyte infiltration, ulceration present or not etc. The only info was Breslow's depth, tumor mass, visual description of the lesion and confirmation of melanoma. The breslow's depth was 4.5mm. I was staged IIb with the only thing keeping me from IIc was ulceration which wasn't mentioned in the second path report. Since there is a LARGE difference in survival rate between IIb and IIc I'm a little concerned about ulceration and it's medical definition regarding melanoma. When my toe was amputated the lesion had "consumed" my entire nail and left a reddish depression where the nail was. There was also flaking skin that sometimes bled and was sore. The entire toe was inflammed and reddish along with the usual dark spots of melanoma cells in and around the former nail bed. It looked ulcerated to me but I'm not sure what the medical definition is. Is it a definite test that is done or is it a subjective observation of the pathologist? Can ulceration be diagnosed by the first punch biopsy? Thanks for any help!

    Viewing 5 reply threads
    • Replies
        Janner
        Participant

          Ulceration cannot be seen with the naked eye.  While some ulcerated lesions will bleed and may look inflamed, it does not mean all lesions that bleed are ulcerated.  Some lesions might look fine but actually have ulceration.  The definition of ulceration is really if the epidermis (top skin layer) is intact.  That has to be seen in a microscopic view.  The integrity of the epidermal layer is examined and if it is not intact, ulceration is present.   I suppose it is subjective to a certain extent – obviously depends on the ability of the pathologist to distinguish this.  But this factor is not one that I've seen disputed much in terms of subjectivity.  As for the pathology report, I've looked at quite a few over the years.  The basic consensus I've come to is that if it is present, it will be called out. Factors that are not present may or may not be described.  So if the report neglects to mention ulceration, it probably means it wasn't found.  Obviously, I can't guarantee this, but this seems to be a trend.  Mitosis is relatively new in the staging scheme of things and is typically only used for stage I.  Some pathologists might not call it out as it hasn't been a long time standard and it isn't used for any diagnostic purposes past stage I.  It would be nice if everyone followed the same format, included the same information and it was uniform.  But unfortunately, it doesn't work that way.

          Best wishes,

          Janner

            losborne00
            Participant

              Janner, Thanks for the info on ulceration. The best info I can find about five year survival is around 70-80 percent for stage IIb and drops to 50-60 percent for stage IIc. The survival rate for stage IIc is actually worse than stage IIIa because  ulceration indicates a more aggressive cancer. That's why I was concerned about the correct observation of ulceration on the path reports. I feel less worried now although I guess the fear of recurrence of this damn disease will never go away.I'm finding it hard to trust doctors because my dermatologist completely screwed up. The melanoma appeared as a dark spot under my toe nail and gradually got worse over the course of six years. About three years before I was diagnosed I had a "complete skin exam" because I have at least 100 moles. The dermatologist had me remove only my shirt and after looking at my trunk and head said I was good to go. The melanoma had been present under my toe for about three years at the time of his exam. If he had just looked at my foot it would have been very obvious and we would have caught this thing about three years earlier. You may be wondering why I didn't have it checked out sooner. Since it was under the nail I thought it was some type of fungus or something. I had never heard of a melanoma in that location. When the nail disappeared and it started to bleed three years later I showed it to my family doctor during a routine yearly physical. I knew something was up when he asked the nurse to get a camera. Anyway thanks again for the information and the links!

              SUE LONSWAY
              Participant

                My husband and youngest daughter have the P16 gene which causes melamona.  My husband has had several.  My older daughter who tested NEGATIVE for the gene was just diagnosed with melanoma at age

                23.  (Genetic testing will be repeated for both daughters soon!)  Strangely, I also had a melanoma in-situ in 2015 at age 51.  

                Even though your post is years old, I just wanted to say that the physician who sent your tissue to be examined should still have possession of the slides and you should be able to have the path report redone by a more reputable lab, such as Johns Hopkins, Mayo Clinic, or University of Pittsburg Medical Center (we use Pittsburg).  Tissue and slides should have not been thrown away. If they were, this would be a reason to make a formal complaint to the hospital or to the physician's state medical board.

                Hope you are well. 

                SUE LONSWAY
                Participant

                  My husband and youngest daughter have the P16 gene which causes melamona.  My husband has had several.  My older daughter who tested NEGATIVE for the gene was just diagnosed with melanoma at age

                  23.  (Genetic testing will be repeated for both daughters soon!)  Strangely, I also had a melanoma in-situ in 2015 at age 51.  

                  Even though your post is years old, I just wanted to say that the physician who sent your tissue to be examined should still have possession of the slides and you should be able to have the path report redone by a more reputable lab, such as Johns Hopkins, Mayo Clinic, or University of Pittsburg Medical Center (we use Pittsburg).  Tissue and slides should have not been thrown away. If they were, this would be a reason to make a formal complaint to the hospital or to the physician's state medical board.

                  Hope you are well. 

                  SUE LONSWAY
                  Participant

                    My husband and youngest daughter have the P16 gene which causes melamona.  My husband has had several.  My older daughter who tested NEGATIVE for the gene was just diagnosed with melanoma at age

                    23.  (Genetic testing will be repeated for both daughters soon!)  Strangely, I also had a melanoma in-situ in 2015 at age 51.  

                    Even though your post is years old, I just wanted to say that the physician who sent your tissue to be examined should still have possession of the slides and you should be able to have the path report redone by a more reputable lab, such as Johns Hopkins, Mayo Clinic, or University of Pittsburg Medical Center (we use Pittsburg).  Tissue and slides should have not been thrown away. If they were, this would be a reason to make a formal complaint to the hospital or to the physician's state medical board.

                    Hope you are well. 

                    losborne00
                    Participant

                      Janner, Thanks for the info on ulceration. The best info I can find about five year survival is around 70-80 percent for stage IIb and drops to 50-60 percent for stage IIc. The survival rate for stage IIc is actually worse than stage IIIa because  ulceration indicates a more aggressive cancer. That's why I was concerned about the correct observation of ulceration on the path reports. I feel less worried now although I guess the fear of recurrence of this damn disease will never go away.I'm finding it hard to trust doctors because my dermatologist completely screwed up. The melanoma appeared as a dark spot under my toe nail and gradually got worse over the course of six years. About three years before I was diagnosed I had a "complete skin exam" because I have at least 100 moles. The dermatologist had me remove only my shirt and after looking at my trunk and head said I was good to go. The melanoma had been present under my toe for about three years at the time of his exam. If he had just looked at my foot it would have been very obvious and we would have caught this thing about three years earlier. You may be wondering why I didn't have it checked out sooner. Since it was under the nail I thought it was some type of fungus or something. I had never heard of a melanoma in that location. When the nail disappeared and it started to bleed three years later I showed it to my family doctor during a routine yearly physical. I knew something was up when he asked the nurse to get a camera. Anyway thanks again for the information and the links!

                      losborne00
                      Participant

                        Janner, Thanks for the info on ulceration. The best info I can find about five year survival is around 70-80 percent for stage IIb and drops to 50-60 percent for stage IIc. The survival rate for stage IIc is actually worse than stage IIIa because  ulceration indicates a more aggressive cancer. That's why I was concerned about the correct observation of ulceration on the path reports. I feel less worried now although I guess the fear of recurrence of this damn disease will never go away.I'm finding it hard to trust doctors because my dermatologist completely screwed up. The melanoma appeared as a dark spot under my toe nail and gradually got worse over the course of six years. About three years before I was diagnosed I had a "complete skin exam" because I have at least 100 moles. The dermatologist had me remove only my shirt and after looking at my trunk and head said I was good to go. The melanoma had been present under my toe for about three years at the time of his exam. If he had just looked at my foot it would have been very obvious and we would have caught this thing about three years earlier. You may be wondering why I didn't have it checked out sooner. Since it was under the nail I thought it was some type of fungus or something. I had never heard of a melanoma in that location. When the nail disappeared and it started to bleed three years later I showed it to my family doctor during a routine yearly physical. I knew something was up when he asked the nurse to get a camera. Anyway thanks again for the information and the links!

                      Janner
                      Participant

                        Ulceration cannot be seen with the naked eye.  While some ulcerated lesions will bleed and may look inflamed, it does not mean all lesions that bleed are ulcerated.  Some lesions might look fine but actually have ulceration.  The definition of ulceration is really if the epidermis (top skin layer) is intact.  That has to be seen in a microscopic view.  The integrity of the epidermal layer is examined and if it is not intact, ulceration is present.   I suppose it is subjective to a certain extent – obviously depends on the ability of the pathologist to distinguish this.  But this factor is not one that I've seen disputed much in terms of subjectivity.  As for the pathology report, I've looked at quite a few over the years.  The basic consensus I've come to is that if it is present, it will be called out. Factors that are not present may or may not be described.  So if the report neglects to mention ulceration, it probably means it wasn't found.  Obviously, I can't guarantee this, but this seems to be a trend.  Mitosis is relatively new in the staging scheme of things and is typically only used for stage I.  Some pathologists might not call it out as it hasn't been a long time standard and it isn't used for any diagnostic purposes past stage I.  It would be nice if everyone followed the same format, included the same information and it was uniform.  But unfortunately, it doesn't work that way.

                        Best wishes,

                        Janner

                        Janner
                        Participant

                          Ulceration cannot be seen with the naked eye.  While some ulcerated lesions will bleed and may look inflamed, it does not mean all lesions that bleed are ulcerated.  Some lesions might look fine but actually have ulceration.  The definition of ulceration is really if the epidermis (top skin layer) is intact.  That has to be seen in a microscopic view.  The integrity of the epidermal layer is examined and if it is not intact, ulceration is present.   I suppose it is subjective to a certain extent – obviously depends on the ability of the pathologist to distinguish this.  But this factor is not one that I've seen disputed much in terms of subjectivity.  As for the pathology report, I've looked at quite a few over the years.  The basic consensus I've come to is that if it is present, it will be called out. Factors that are not present may or may not be described.  So if the report neglects to mention ulceration, it probably means it wasn't found.  Obviously, I can't guarantee this, but this seems to be a trend.  Mitosis is relatively new in the staging scheme of things and is typically only used for stage I.  Some pathologists might not call it out as it hasn't been a long time standard and it isn't used for any diagnostic purposes past stage I.  It would be nice if everyone followed the same format, included the same information and it was uniform.  But unfortunately, it doesn't work that way.

                          Best wishes,

                          Janner

                          MichaelFL
                          Participant

                            Curious, have you had a SNB-Sentinel node biopsy? Was it negative?

                              losborne00
                              Participant

                                I did have a sentinel node biopsy and it was negative. I was very blessed! After pressing my surgical oncologist prior to surgery he said that he would be surprised if it was negative due to the location, depth and length of time the melanoma had been present. I'm a lucky man!smiley

                                losborne00
                                Participant

                                  I did have a sentinel node biopsy and it was negative. I was very blessed! After pressing my surgical oncologist prior to surgery he said that he would be surprised if it was negative due to the location, depth and length of time the melanoma had been present. I'm a lucky man!smiley

                                  losborne00
                                  Participant

                                    I did have a sentinel node biopsy and it was negative. I was very blessed! After pressing my surgical oncologist prior to surgery he said that he would be surprised if it was negative due to the location, depth and length of time the melanoma had been present. I'm a lucky man!smiley

                                  MichaelFL
                                  Participant

                                    Curious, have you had a SNB-Sentinel node biopsy? Was it negative?

                                    MichaelFL
                                    Participant

                                      Curious, have you had a SNB-Sentinel node biopsy? Was it negative?

                                  Viewing 5 reply threads
                                  • You must be logged in to reply to this topic.
                                  About the MRF Patient Forum

                                  The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

                                  The information on the forum is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.