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Update and Question

Forums Cutaneous Melanoma Community Update and Question

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      Hi Everyone,

      I posted a while ago about my daughter's pathology report (she is 11) and wanted to give an update and had a few questions. 

      She had 2 moles removed and originally one of them came back as a combined mole with features of a spitz nevus and features of a halo (she did not have a halo around the mole it just showed inflammation on pathology) so we were sent to a pediatric specialist. Thankfully the local children's hospital opened a Melanoma and nevus clinic last fall. Her dermatologist was great and requested to get the original slides to have their dermatopathologist look at them since she said they have had kids sent there with a melanoma diagnosis that ended up not being melanoma and vice versa and wanted to wait to see what they said before deciding what to do. It seemed like an eternity but after a few weeks her Dr called and said their pathologist didn't see spitz like the other pathologists but that they saw a combined nevus with clonal or inverted type a along with the halo features even though she did not have an actual halo. She said she did not need to go back in and do a WLE but she would need to follow up more often and see her again in 6 months so we were very thankful for that! 

      The mole was removed by shave biopsy just over 8 weeks ago and it is still painful to touch (we thought it was just the healing process) and unlike the one removed on her leg it is now raised, even more than the original mole was. She also has a much smaller mole that is close to where the original mole was that she was complaining was also hurting/itching and it was slightly pink on one side of that mole. We only had them look at the original mole because she kept saying it was itchy and bothering her. It doesn't look infected or anything but I called her dermatologist this week and they want her to come back in next week to look at it but I just wanted to see if this is common and just part of the healing process or if anyone else has experience something like this? I was also wondering if anyone has any information about the difference between a combined nevus with spitz and one with clonal/inverted type a. We were told spitz looks similar to melanoma so do clonal/inverted type a also look like melanoma? Thanks!!

      Pathology info:

      Combined melanocytic nevus with focal epithelioid cells and features of a ‘halo’ nevus note: The features are compatible with a so-called “clonal nevus” or “inverted type A nevus” The epithelioid component has been regarded by some to represent a superficial variant of deep penetrating nevus.

      Microscopic: There are nests, cords and strands of small, monomorphous melanocytes within the dermis where there are also focal nests of larger epithelioid melanocytes that have abundant cytoplasms containing fine, dusty melanin and rare admixed melanophages. There is also a dense lymphocytic inflammatory infiltrate within the dermis that focally obscures the melanocytes. A panel of immunostains was provided for review. BAP-1 expression is retained throughout the lesion, which is a 
normal finding. The remainder of the stains are non-contributory.

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