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Very Weird and Large Amelanotic Melanoma Update

Forums General Melanoma Community Very Weird and Large Amelanotic Melanoma Update

  • Post
    kellylizzz
    Participant

      Here is the path report from the first exision on 8/16/18

       

      FINAL DIAGNOSIS:

      Skin, left postauricular scalp, excision: Inflammation, fibrosis, and
      residual melanoma, widely excised.

      CLINICAL INFORMATION:
      Specimen(s): Left postauricular scalp, melanoma, additional donut,
      stitch at 12 o'clock. ICD code(s): C43.9.

      GROSS DESCRIPTION:
      The specimen is received in a formalin-filled container having the
      patient's printed identification data including the patient's name
      "Patient Name" The specimen consists of a non-elliptical, somewhat
      circular donut-shaped biopsy of skin marked with a suture with
      orientation as indicated on the requisition site/other. This is then
      designated the "12 o'clock position". The outside diameter of the donut
      biopsy measures 10.7 x 10 cm to a depth of 0.5 cm. The inside diameter
      of the donut biopsy measures 7 x 6.5 cm to a depth of 0.5 cm. The
      outside margin is inked green; the inside margin is inked black. The
      surface of the skin is variably beige to light tan with dark hair
      extending from the 4 o'clock position until the 11 o'clock position. The
      measurement of skin wideness at the 12 o'clock position is 1.9 cm, 1
      o'clock position is 1.8 cm, 2 o'clock position is 1.9 cm, 3 o'clock
      position is 2 cm, 4 o'clock position is 1.8 cm, 5 o'clock position is 2
      cm, 6 o'clock position is 1.7 cm, 7 o'clock position is 1.6 cm, 8
      o'clock position is 1.5 cm, 9 o' clock is 1.7 cm, 10 o'clock position is
      0.8 cm, and the 11 o'clock position is 2 cm. The ellipse is serially
      sectioned in a clockwise direction into 74 pieces and entirely embedded
      in 25 cassettes with seven sections from the 12 o'clock to 1 o'clock
      position embedded in cassettes A1-A3, five sections from the 1 o'clock
      to 2 o'clock position embedded in cassettes A4-A5, five sections from
      the 2 o'clock to 3 o'clock position embedded in cassettes A6-A7, six
      sections from the 3 o'clock to 4 o'clock position embedded in cassettes
      A8-A9, six sections from the 4 o'clock to 5 o'clock position embedded in
      cassettes A10-A11, five sections from the 5 o'clock to 6 o'clock
      position embedded in cassettes A12-A13, six sections from the 6 o'clock
      to 7 o'clock position embedded in cassettes A14-A15, six sections from
      position 7 o'clock to 8 o'clock embedded in cassette A16-A17, eight
      sections from positions 8 o'clock to 9 o'clock embedded in cassettes
      A18-A19, eight sections from positions 9 o'clock to 10 o'clock embedded
      in cassettes A20-A21, seven sections from positions 10 o'clock to 11
      o'clock are embedded in cassettes A22-A23, and five sections from
      position 11 o'clock to 12 o'clock are embedded in cassettes A24-A25.
      (re/mm)

      MICROSCOPIC DESCRIPTION:
      There is inflammation and fibrosis characteristic of prior procedure
      site. There is residual atypical nested melanocytes at the
      dermoepidermal junction and in the superficial dermis, characteristic of
      residual melanoma. The specimen was labeled with antibodies to Melan-A
      (see below) which better delineated the neoplasm. Margins are widely
      free of the neoplasm in the examined sections.

      IMMUNOHISTOCHEMISTRY STUDY:
      Deparaffinized sections of formalin-fixed tissue and the appropriate
      controls are incubated with the antibodies/antibody listed below.
      Localization is via: biotin free multimer immunoperoxidase method.
      Results are outlined in the table below:
      Block A1
      Cells of interest

      Antibody  Result    Comment
      Melan A RED    Positive

      Block A2
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A3
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A4
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A5
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A6
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A7
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A8
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A9
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A10
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A11
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A12
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A13
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A14
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A15
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A16
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A17
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A18
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A19
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A20
      Cells of interest

      AntibodyResultComment
      Melan A RED    Negative

      Block A21
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A22
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A23
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A24
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

      Block A25
      Cells of interest

      AntibodyResultComment
      Melan A RED    Positive

    Viewing 3 reply threads
    • Replies
        kellylizzz
        Participant

          Skin, left scalp, excision: Malignant melanoma, see below and comment.

               Histologic Type: Amelanotic melanoma.
               Maximum Tumor Thickness: 1.5 mm.
               Anatomic Level: Clark level IV.
               Ulceration: Present.
               Peripheral Margins: Involved my invasive melanoma, see comment.
               Deep Margin: Uninvolved by invasive melanoma.
               Mitotic Index: Approximately 1/mm2.
               Microsatellitosis: Not identified.
               Lymph-Vascular Invasion: Not identified.
               Perineural Invasion: Not identified.
               Tumor Infiltrating Lymphocytes: Not identified.
               Tumor Regression: Present, involving <75% of lesion.
               Pathologic Stage: At least T2b.

          CLINICAL INFORMATION:
          Specimen(s): Excision, left scalp, melanoma, check margins, stitch at 12
          o'clock. ICD Code(s): D03.4.

           

           

           

          Post Re-Excision: 

          FINAL DIAGNOSIS: Skin, left postauricular scalp, excision: Inflammation, Fibrosis, and residual melanoma, widely excised.

          CLINICAL INFORMATION:
          Specimens (s): Left postauricular scalp, melanoma, additional donut, stitch at 12 o'clock. ICD code (s): C43.9.

          GROSS DESCRIPTION:
          The specimen is received in a formalin-filled container having the patient's printed identification data including the patient's name. The speciment consists of a non-elliptical, somewhat circular donut-shaped biopsy of skin marked with a suture with orientation as indicated on the requistition site/other. This is then designated the "`12 o'clock position". The outside diameter of the donut biopsy measures 10.7 x 10 cm to a depth of .5cm. The inside diamer of the dnout biopsy measures 7 x 6.5 cm to a depth of .5 cm. The outside margin is inked green green; the inside margin is inked black. The surface of the skin is variable veige to light tan with dark hair extending from the 4 o'clock position until the 11 o'clock position. The measurement of skin wideness at the 12 o'clock position is 1.9 cm, 1 o'clock position is 1.8 cm, 2 o'clock position is 1.9 cm, 3 o'clock position is 2cm, 4 o'clock position is 1.8cm, 5 o'clock position is 2 cm, 6 o'clock position is 1.7 cm, 7 o'clock position is 1.6 cm, 8 o'clock position is 1.5 cm, 9 o'clock pisition is 1.7cm, 10 o clock is 0.8 cm, and 11 o'clock is 2cm. The ellipse is serially sectioned in a clockwise direction into 74 pieces and entriely embedded in 25 cassettes.

          MICROSCOPIC DESCRIPTION:
          There is inflammation and fibrosis characteristic of prior procedure site. There is residual atyptical nested melanocytes at the dermoepidermal junction and in the superficial dermis, characteristic of residual melanoma. The specimen was labled with antibodies to melan-a, which better delineated the neoplasm. Margins are widely free of the neoplasm in the examined sections.

          IMMUNOHISTOCHEMISTRY STUDY:
          Deparaffinized sections of formalin-fixed tissue and the appropriate controls are incubated with the antibodies/andibody listed below. Localization is via: biotin free multimer immunoperoxidase method. Results are outlined in the table below:

          Block A1
          Cells of Interest

          Melan A RED Positive

          Block A2
          Melan A RED Positive

          Block A3

          Melan A RED Positive

          Block A4

          Melan A RED Positive

          Block A5

          Melan A RED Negative

          Block A6
          Melan A RED  Negative

          Block A7
          Melan A RED  Negaitve

          Block A8
          Melan A RED Negative

          Block A9
          Melan A RED  Positive

          Block A10

          Melan A RED  Negative

          Block A11
          Melan A RED  Negaitve

          Block A12
          Melan A RED Positive

          Block A13
          Melan A RED Negative

          Block A14

          Melan A RED  Negative

          Block A15
          Melan A RED  Negative

          Block A16

          Melan A RED Negative

          Block  A17
          Melan A RED  Negative

          Block A18
          Melan A RED  Positive

          Block A19
          Melan A RED Positive

          Block A20

          Melan A RED Negative

          Block A21
          Melan A RED  Positive

          Block A22
          Melan A RED Positive

          Block A23
          Melan A RED Positive

          Block A24
          Melan A RED Positive

          Block A25
          Melan A RED Positive

            kellylizzz
            Participant

              I have a sentinal node biopsy on Friday and they're doing the skin graft reconstruction friday as well, so I'll know in about 2 weeks whether my lymph nodes have been impacted or not. 

              Mark_DC
              Participant

                Good luck Kellylizzz – you have a lot on on Friday, hope everything goes really well

              QuietPoet
              Participant

                Best of luck with everything tomorrow. I hope you have a good support network at home.

                lkb
                Participant

                  Hey kellylizzz, more on the donor site for skin graft: Mine was not healing well until we siwtched dressings. Now using honey-infused foam and the healing is finally making good progress. Wish I would have known of that option months earlier, hoping it can help you.

                  kellylizzz
                  Participant
                    A very late reply but thank y’all for your support! My fiance at the time husband now was an angel and did all of the head woundcare and most of the leg woundcare for me, everything healed really really well. It was hell to exist for two weeks after having been essentially medically scalped on half my head, had to wear a bandage 24/7 for those two weeks and couldn’t shower really. Then they did the skin graft surgery which went largely super well, besides how I woke up. For some reason my silly groggy brain thought “hey my leg is itchy, let’s reach under the bandages and give it a good scratch” so that’s what I did, and I woke up to the nurses yelling “NO NO NO!” and grabbing my hand lol. Thankfully I didn’t manage to do much damage and it healed fine. Once the skin graft was on, I had to wear a pressure bandage for like two weeks I think? And also couldn’t really shower. It was an icky time lol. Lots of sponge baths. With all the pain one of the most annoying things was the whole not being able to shower thing.

                    The donor site on my leg was definitely way more painful than my scalp situation where the graft covered was. We used so much xiroform, it was a lifesaver. The skin graft looked super weird for a while but now it looks like normal skin, just smoother.

                    Also found out I have a genetic predisposition to melanoma due to the CDK2NA gene, from my dad’s side. He actually had melanoma behind his left ear just like me in 2021! It was removed quickly thankfully, no need for a graft for him since it was caught so early.

                    Found out my half sister also had melanoma on her neck, so it seems our family likes to put melanoma on our heads for some reason.

                    Anyway, I was super lucky to have my husband with me. I would have had to go to a rehab facility or had home nurses come to do my wound care for me since I couldn’t even see the part of my head it was on. With his help, everything healed better than expected. My hair covers the graft so it’s not even visible unless I have my hair up, then it looks like a permanent undercut. It’s wild to now have a freckle on my scalp that used to be on my thigh lol. But now it’s been 4 years and so far no new melanomas have popped up. I’ll have 6 monthly skin checks for the rest of my life of course.

                    Anyway thanks for y’alls support this forum was very helpful for me when I was going through it.

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