Update on 5 year old Spitz Atypical Spitzoid Neoplasm

Hi

I am glad to see that Sloan requested the FISH test.  Remember that the FISH test has 100% sensitivity (if the sample is melanoma, the test will detect melanoma 100% of the time) but it does not have 100% specificity.  Sometimes it will fail to detect melanoma and instead classify the sample as Spitz.   Thus, in some small percent of cases like your son's, the test will say "No melanoma" when in fact there is melanoma.  This is why there is uncertainty, but looking on the bright side, odds are that your son's "mole" is a Spitz nevus.  Most of the time, the FISH test is correct.

I would err on the side of safety and have the re-excision with sentinel lymph node biopsy.   If anything shows up in the lymph node then there is more to test with the FISH assay.  Hopefully nothing will show up and then you will have that peace of mind.  Our son has recovered faster than expected from each surgery (three); your son is likely tougher than you image (ours has been!!).  I realize this is a lot for a little guy.  For us, we needed to feel like we did everything possible so that if melanoma ever comes back, we won't regret not doing what we could at the time.

Hi

I am glad to see that Sloan requested the FISH test.  Remember that the FISH test has 100% sensitivity (if the sample is melanoma, the test will detect melanoma 100% of the time) but it does not have 100% specificity.  Sometimes it will fail to detect melanoma and instead classify the sample as Spitz.   Thus, in some small percent of cases like your son's, the test will say "No melanoma" when in fact there is melanoma.  This is why there is uncertainty, but looking on the bright side, odds are that your son's "mole" is a Spitz nevus.  Most of the time, the FISH test is correct.

I would err on the side of safety and have the re-excision with sentinel lymph node biopsy.   If anything shows up in the lymph node then there is more to test with the FISH assay.  Hopefully nothing will show up and then you will have that peace of mind.  Our son has recovered faster than expected from each surgery (three); your son is likely tougher than you image (ours has been!!).  I realize this is a lot for a little guy.  For us, we needed to feel like we did everything possible so that if melanoma ever comes back, we won't regret not doing what we could at the time.

Hi

I am glad to see that Sloan requested the FISH test.  Remember that the FISH test has 100% sensitivity (if the sample is melanoma, the test will detect melanoma 100% of the time) but it does not have 100% specificity.  Sometimes it will fail to detect melanoma and instead classify the sample as Spitz.   Thus, in some small percent of cases like your son's, the test will say "No melanoma" when in fact there is melanoma.  This is why there is uncertainty, but looking on the bright side, odds are that your son's "mole" is a Spitz nevus.  Most of the time, the FISH test is correct.

I would err on the side of safety and have the re-excision with sentinel lymph node biopsy.   If anything shows up in the lymph node then there is more to test with the FISH assay.  Hopefully nothing will show up and then you will have that peace of mind.  Our son has recovered faster than expected from each surgery (three); your son is likely tougher than you image (ours has been!!).  I realize this is a lot for a little guy.  For us, we needed to feel like we did everything possible so that if melanoma ever comes back, we won't regret not doing what we could at the time.

I think that they don't really think this is melanoma based upon the path and testing, but the testing only includes a small sample of tissue.  Pathology reports typically err on the side of caution if there is any possibility of multiple diagnoses.  Since the tumor is not completely removed, they cannot rule out melanoma in the remaining tissue.  Since the SNB ideally needs to be done before the wide excision, that is why they are recommonding your son do both as the next step.  So while all signs are currently saying benign, they are recommending treatment based on worst case scenario since the entire lesion hasn't been analyzed.  Not necessarily comforting, but erring on the side of caution which is how most of us would like to treated.

Best wishes,

Janner

I think that they don't really think this is melanoma based upon the path and testing, but the testing only includes a small sample of tissue.  Pathology reports typically err on the side of caution if there is any possibility of multiple diagnoses.  Since the tumor is not completely removed, they cannot rule out melanoma in the remaining tissue.  Since the SNB ideally needs to be done before the wide excision, that is why they are recommonding your son do both as the next step.  So while all signs are currently saying benign, they are recommending treatment based on worst case scenario since the entire lesion hasn't been analyzed.  Not necessarily comforting, but erring on the side of caution which is how most of us would like to treated.

Best wishes,

Janner

I think that they don't really think this is melanoma based upon the path and testing, but the testing only includes a small sample of tissue.  Pathology reports typically err on the side of caution if there is any possibility of multiple diagnoses.  Since the tumor is not completely removed, they cannot rule out melanoma in the remaining tissue.  Since the SNB ideally needs to be done before the wide excision, that is why they are recommonding your son do both as the next step.  So while all signs are currently saying benign, they are recommending treatment based on worst case scenario since the entire lesion hasn't been analyzed.  Not necessarily comforting, but erring on the side of caution which is how most of us would like to treated.

Best wishes,

Janner