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understanding pathology reports

Forums General Melanoma Community understanding pathology reports

  • Post
    lindas58
    Participant

      A person gets a biopsy & a pathologist report. In the report it state breslow depth, clarks level & wether its ulcerated. Surgery is done to remove the melanoma & more measurements are done which are smaller. My question is does a person add the two measurements together? Which one is accurate/

      A person gets a biopsy & a pathologist report. In the report it state breslow depth, clarks level & wether its ulcerated. Surgery is done to remove the melanoma & more measurements are done which are smaller. My question is does a person add the two measurements together? Which one is accurate/

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        Janner
        Participant

          If the first biopsy did not remove the entire lesion and there is additional depth in the wide excision, you can only accurately say your lesion was AT LEAST XX deep where XX is the depth on the first biopsy report.  When they read your pathology slides, the slide the sample into tiny slices.  When they do the second excision, they also cut it up into small slices.  However, there is no way to match the slides from the first sample with the 2nd sample.  You may pick the deepest part of the first, but try to combine it with another slide of the second– but the second slide is on the outside of the lesion, not the center.  There is just no way to make combining the two samples work.  So, all you can really say is your lesion was at least XX deep with some residual melanoma left.   This is one reason why many prefer not to have shave biopsies – other biopsy types don't tend to cut through lesions so you don't lose that important staging information.  Sorry, I might have rambled a bit but I hope you understand what I'm saying.

          Best wishes,

          Janner

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          Janner
          Participant

            If the first biopsy did not remove the entire lesion and there is additional depth in the wide excision, you can only accurately say your lesion was AT LEAST XX deep where XX is the depth on the first biopsy report.  When they read your pathology slides, the slide the sample into tiny slices.  When they do the second excision, they also cut it up into small slices.  However, there is no way to match the slides from the first sample with the 2nd sample.  You may pick the deepest part of the first, but try to combine it with another slide of the second– but the second slide is on the outside of the lesion, not the center.  There is just no way to make combining the two samples work.  So, all you can really say is your lesion was at least XX deep with some residual melanoma left.   This is one reason why many prefer not to have shave biopsies – other biopsy types don't tend to cut through lesions so you don't lose that important staging information.  Sorry, I might have rambled a bit but I hope you understand what I'm saying.

            Best wishes,

            Janner

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            MichaelFL
            Participant

              Are you just asking out of curiosity, or do you have a copy of your pathology report and perhaps there are some questions you need answered? If so, can you post it? That may help.

              As an example though, if the first biopsy did not get all of the depth portion of the melanoma tumor, it may say something like-the depth is "at least such and such" or it may mention that the melanoma tumor was transected, or cut through, or that the biopsy extended to the edge of the depth margin.

              Sadly, there are as yet no uniform guidelines for pathology reports, and sometimes the wording varies greatly and may be difficult to understand based on where one resides, the doctor, pathologist, lab. etc.

              Michael

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                lindas58
                Participant

                  pre-surgery

                  Gross Describtion

                  Upper back

                  received in formalin designated on the requisition form to be from "skin" is a shaved portion of unoriented tan-brown

                  firm to rubbery skin measuring 1.6 x 1.1 cm. Marked blue, sectioned and entirely submitted in a single cassette.

                  Microscopic Describtion:

                  Slides examined. Sections show a melanocytic proliferation consisting of predominantly of junctional nests with atypia, with infrequent papillary dermal junction melanocytic nests. Occasional individual atypical melanocytes percolate into low to mid epidermis.

                  Addendum:

                  Severely atypical compound melanocytic proliferation favor superficially invasive malignant melanoma, breslow depth depth 0.42 mm, Clarks level lll, extending to one lateral margin.

                  Post surgery:

                  Melanoma-back is in oriented lightly pigmented ellipse of skin with underlying subcutaneous tissue, marked with a long white suture at the superior margin, short white suture at the inferior margin,long black suture at the left margin and short black suture at the right margin. The tissue measures 7.9 cm from the superior to inferior x 2.4 cm from right to leftand is excised to a maximum depth of 2 cm. The skin surface displays a central depressed tan lession which measures 1.4 x 0.8 cm and comes to  within 0.4 cm from the left side margin, 0.8cm from the right side margin, 3.1 cm from the inferior margin, and 3.3 cm from the superior margin. The margins are differentially inked as follows: superior to right blue, right to inferior orange, and inferior to lateral to superior black. Sectioning reveals that the depressed central lession extends a depth of 0.2 cm.Representative sections are submitted as follows;C1 superior tip perpendicular, c2-c7 one slice per cassette to contain the entire central depressed ulcerative lesion cb inferior tip perpendicular.

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                  MichaelFL
                  Participant

                    Always good to know who someone is, and this additional information helps greatly. Thanks!

                    Based on what you have typed here, I believe that the "depth" portion of your husbands of the lesion is accurate as it clearly states that the Breslow depth is .42 mm. The melanoma does however extedn to one of the lateral (side) margins. This does happen now and then, and that is why the second surgery (which is called a WLE) is performed to achieve clear margins all around.

                    One again, the Breslow depth is portion of the lesion clearly states .42 mm, and of all the margins the depth is the one that is the most important as that tells you how deep it has gone into the three layers of skin.

                    The Clarks levels also tells you how far the lesion extends into the epidermis, dermis or subcutaneous fat.

                    Clarks Levels:

                    The Clark level refers to how deep the tumor has penetrated into the layers of the skin. This system was originally developed by W. H. Clark, MD back in 1966. Clark levels are officially defined as follows:

                    • Level I: confined to the epidermis (top-most layer of skin); called "in situ" melanoma; 100% cure rate at this stage
                    • Level II: invasion of the papillary (upper) dermis
                    • Level III: filling of the papillary dermis, but no extension in to the reticular (lower) dermis
                    • Level IV: invasion of the reticular dermis
                    • Level V: invasion of the deep, subcutaneous tissue

                    Since 2002, Clark's levels have been used less and less for calculating prognosis, since research has shown them to be less predictive of outcome, less reproducible and more subjective than the Breslow depth. Other disadvantages of this system are that it is often very difficult to differentiate between Clark Level II and Level III, and it can't be used on melanomas of the palms and soles.

                    Hope this helps some, and once again congratulations to your husband for having a clear SNB.

                    Keep up those doctor visits. And if you still feel you have questions, feel free to discuss it with his doctor. If you then still feel unsure about things, a second opinion never hurts.

                    Michael stage 1b-Breslow .30 mm, Clarks Level II

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                    MichaelFL
                    Participant

                      Always good to know who someone is, and this additional information helps greatly. Thanks!

                      Based on what you have typed here, I believe that the "depth" portion of your husbands of the lesion is accurate as it clearly states that the Breslow depth is .42 mm. The melanoma does however extedn to one of the lateral (side) margins. This does happen now and then, and that is why the second surgery (which is called a WLE) is performed to achieve clear margins all around.

                      One again, the Breslow depth is portion of the lesion clearly states .42 mm, and of all the margins the depth is the one that is the most important as that tells you how deep it has gone into the three layers of skin.

                      The Clarks levels also tells you how far the lesion extends into the epidermis, dermis or subcutaneous fat.

                      Clarks Levels:

                      The Clark level refers to how deep the tumor has penetrated into the layers of the skin. This system was originally developed by W. H. Clark, MD back in 1966. Clark levels are officially defined as follows:

                      • Level I: confined to the epidermis (top-most layer of skin); called "in situ" melanoma; 100% cure rate at this stage
                      • Level II: invasion of the papillary (upper) dermis
                      • Level III: filling of the papillary dermis, but no extension in to the reticular (lower) dermis
                      • Level IV: invasion of the reticular dermis
                      • Level V: invasion of the deep, subcutaneous tissue

                      Since 2002, Clark's levels have been used less and less for calculating prognosis, since research has shown them to be less predictive of outcome, less reproducible and more subjective than the Breslow depth. Other disadvantages of this system are that it is often very difficult to differentiate between Clark Level II and Level III, and it can't be used on melanomas of the palms and soles.

                      Hope this helps some, and once again congratulations to your husband for having a clear SNB.

                      Keep up those doctor visits. And if you still feel you have questions, feel free to discuss it with his doctor. If you then still feel unsure about things, a second opinion never hurts.

                      Michael stage 1b-Breslow .30 mm, Clarks Level II

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                      lindas58
                      Participant

                        pre-surgery

                        Gross Describtion

                        Upper back

                        received in formalin designated on the requisition form to be from "skin" is a shaved portion of unoriented tan-brown

                        firm to rubbery skin measuring 1.6 x 1.1 cm. Marked blue, sectioned and entirely submitted in a single cassette.

                        Microscopic Describtion:

                        Slides examined. Sections show a melanocytic proliferation consisting of predominantly of junctional nests with atypia, with infrequent papillary dermal junction melanocytic nests. Occasional individual atypical melanocytes percolate into low to mid epidermis.

                        Addendum:

                        Severely atypical compound melanocytic proliferation favor superficially invasive malignant melanoma, breslow depth depth 0.42 mm, Clarks level lll, extending to one lateral margin.

                        Post surgery:

                        Melanoma-back is in oriented lightly pigmented ellipse of skin with underlying subcutaneous tissue, marked with a long white suture at the superior margin, short white suture at the inferior margin,long black suture at the left margin and short black suture at the right margin. The tissue measures 7.9 cm from the superior to inferior x 2.4 cm from right to leftand is excised to a maximum depth of 2 cm. The skin surface displays a central depressed tan lession which measures 1.4 x 0.8 cm and comes to  within 0.4 cm from the left side margin, 0.8cm from the right side margin, 3.1 cm from the inferior margin, and 3.3 cm from the superior margin. The margins are differentially inked as follows: superior to right blue, right to inferior orange, and inferior to lateral to superior black. Sectioning reveals that the depressed central lession extends a depth of 0.2 cm.Representative sections are submitted as follows;C1 superior tip perpendicular, c2-c7 one slice per cassette to contain the entire central depressed ulcerative lesion cb inferior tip perpendicular.

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                      MichaelFL
                      Participant

                        Are you just asking out of curiosity, or do you have a copy of your pathology report and perhaps there are some questions you need answered? If so, can you post it? That may help.

                        As an example though, if the first biopsy did not get all of the depth portion of the melanoma tumor, it may say something like-the depth is "at least such and such" or it may mention that the melanoma tumor was transected, or cut through, or that the biopsy extended to the edge of the depth margin.

                        Sadly, there are as yet no uniform guidelines for pathology reports, and sometimes the wording varies greatly and may be difficult to understand based on where one resides, the doctor, pathologist, lab. etc.

                        Michael

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