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CJK.
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- July 27, 2011 at 2:22 pm
Hi all
I've been following this forum pretty closely since I was diagnosed with melanoma about a week ago, and thought I would ask for some help understanding my histology report.
I had a skin shave biopsy of a mole on my shoulder in June. I think it grew over the course of about 6 months (it bled in the last month or so). My GP thought it was a pyogenic granuloma – hence the skin shave biopsy. It was nodular malignant melanoma.
Hi all
I've been following this forum pretty closely since I was diagnosed with melanoma about a week ago, and thought I would ask for some help understanding my histology report.
I had a skin shave biopsy of a mole on my shoulder in June. I think it grew over the course of about 6 months (it bled in the last month or so). My GP thought it was a pyogenic granuloma – hence the skin shave biopsy. It was nodular malignant melanoma.
I had a CT scan but have not received the results. I am scheduled for my WLE and SNLB in a couple of weeks and I know the results from these will determine the staging. In the meantime, I am trying to better understand my situation so I can prepare myself. If possible, I would like to know the good and the bad signs of the report. Here are the details:
Macroscopic description:
10 x 3 x 7 mm
Histology:
The skin shave specimen shows an extensively ulcerated malignant melanoma in the vertical growth phase. It is composed of variably sized nests and sheets of pleomorphic melanocytes which lack maturation with depth. Deep dermal mitotic figures are identified and occasional cells show cytoplasmic melanin pigmentation. In this sample, the depth of invasion is at least 3.2 mm. The presence of a junctional component is difficult to assess due to epidermal ulceration. On immunohistochemistry, the tumor cells are positive for S1oo and Melan-A and show focal positivity for HMB-45. It is widely present at the margins of this shave sample.
From what I have read, a 3.2mm ulcertated tumor is IIB, is this correct? Can anyone make sense of the sentence about the 'variably sized nests'? Is it a good sign that the pleomorphic melanocytes lack maturation with depth? I'm not certain if it is abnormal, but when my GP was removing the tumor via skin shave she said it almost fell off. Granted, I had bumped my shoulder against a wall the week before and done most of the work for her, pretty well ripping the mole out of my arm. I didn't receive the numerical figure of the mitotic rate, but is there any indication from the description in the report? Finally what is the significance of a junctional component or the presence of melanoma at the margins of the shave sample?
I realize there are quite a few questions here (of course, it's not the half of them). Any assistance would really be appreciated.
Thanks
CJ
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- July 27, 2011 at 2:57 pm
In general, it doesn't do much good trying to analyze the entire path report. When the pathologist describes nests and maturation, etc., s/he is justifying the diagnosis of melanoma. Confirming that characteristics exist that comprise that diagnosis. There isn't really anything "good" about any of it. You basically just look for the key factors that are used in prognosis such as depth, ulceration, and mitosis. These are the important bits. You might have a preliminary staging of IIB now, but final staging can't be done until all the results (scans, SNB) are in. You can ask for clarification of the mitotic rate, but right now – for staging purposes – it's either <1 or 1+. Since yours identifies "mitotic figures", that implies more than 1. I'm not sure that knowing if it is 2 or 4 really makes much difference at this point. You can also send the slides off for a second opinion if you choose.
Right now, the key will be getting the scans and WLE/SNB done so you can complete the staging and look at any treatment options you might pursue. Are you being seen by a melanoma specialist?
Best wishes,
Janner
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- July 27, 2011 at 2:57 pm
In general, it doesn't do much good trying to analyze the entire path report. When the pathologist describes nests and maturation, etc., s/he is justifying the diagnosis of melanoma. Confirming that characteristics exist that comprise that diagnosis. There isn't really anything "good" about any of it. You basically just look for the key factors that are used in prognosis such as depth, ulceration, and mitosis. These are the important bits. You might have a preliminary staging of IIB now, but final staging can't be done until all the results (scans, SNB) are in. You can ask for clarification of the mitotic rate, but right now – for staging purposes – it's either <1 or 1+. Since yours identifies "mitotic figures", that implies more than 1. I'm not sure that knowing if it is 2 or 4 really makes much difference at this point. You can also send the slides off for a second opinion if you choose.
Right now, the key will be getting the scans and WLE/SNB done so you can complete the staging and look at any treatment options you might pursue. Are you being seen by a melanoma specialist?
Best wishes,
Janner
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- July 27, 2011 at 3:30 pm
Hi CJ, and welcome to the forum no one wants to be a member of by choice. It has been busy on this forum over the last few days.
I see from your profile that you are in London. Are you being seen by a melanoma specialist? Among other things, due to the depth of the lesion, a SNB/WLE should be performed.
Yes, IIB is correct thus far, but that may change with the SNB.
I can help you with some of the definitions, but as Jan said. It really does not do any good to break down the entire report as this is mainly just a description of what is seen under the microscope. The most important thing is the Breslow depth. Some other things you may wish to learn about are ulceration and mitotic rate.
Pleomorphic melanocytes means that there are melanocytes in different forms of the cell life cycle. It really is just a description of what is seen. Not really important concerning your diagnosis.
Deep dermal mitotic figures are identified shows that there was some cell division, but you will have to ask for clarification as to if there is a mitotic rate number. As Jan said, it may not mean much at this point as you need to have a SNB/WLE done anyway due to the depth of the lesion.
The fact that you state "the depth of invasion is at least 3.2 mm" may mean that the shave was transected or cut through. You may ask for clarification on that as well.
"It is widely present at the margins of this shave sample"-means that melanoma cells were present at the margins. This also tells me either that margins are not clear and/or the shave was cut through. You should ask what margins they a referring to. Side (lateral) or depth. It seems to me from what you stated that it was all margins, both side and depth.
Again, it seems the shave my have cut through the lesion, or due to the fact you bumped it there was damage. Or both. At any rate, due to the depth and that there are not clear margins, a SNB/WLE needs to be performed. Scans as well to see if it has spread further.
Good luck, and keep us posted.
Michael
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- July 27, 2011 at 3:30 pm
Hi CJ, and welcome to the forum no one wants to be a member of by choice. It has been busy on this forum over the last few days.
I see from your profile that you are in London. Are you being seen by a melanoma specialist? Among other things, due to the depth of the lesion, a SNB/WLE should be performed.
Yes, IIB is correct thus far, but that may change with the SNB.
I can help you with some of the definitions, but as Jan said. It really does not do any good to break down the entire report as this is mainly just a description of what is seen under the microscope. The most important thing is the Breslow depth. Some other things you may wish to learn about are ulceration and mitotic rate.
Pleomorphic melanocytes means that there are melanocytes in different forms of the cell life cycle. It really is just a description of what is seen. Not really important concerning your diagnosis.
Deep dermal mitotic figures are identified shows that there was some cell division, but you will have to ask for clarification as to if there is a mitotic rate number. As Jan said, it may not mean much at this point as you need to have a SNB/WLE done anyway due to the depth of the lesion.
The fact that you state "the depth of invasion is at least 3.2 mm" may mean that the shave was transected or cut through. You may ask for clarification on that as well.
"It is widely present at the margins of this shave sample"-means that melanoma cells were present at the margins. This also tells me either that margins are not clear and/or the shave was cut through. You should ask what margins they a referring to. Side (lateral) or depth. It seems to me from what you stated that it was all margins, both side and depth.
Again, it seems the shave my have cut through the lesion, or due to the fact you bumped it there was damage. Or both. At any rate, due to the depth and that there are not clear margins, a SNB/WLE needs to be performed. Scans as well to see if it has spread further.
Good luck, and keep us posted.
Michael
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Tagged: cutaneous melanoma
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