what can this mean?

Pathology is as much an art as a science.  Ideally the slides are being read by a dermatopathologist – a pathologist that specializes in skin pathology.  When a pathologist looks at a slide, there are many factors they look at.  Some factors may indicate cancer, some may be atypical, some may be normal.  They basically weigh all the different indicators and make an educated opinion on whether or not this is melanoma in situ or severely atypical.  There are no absolutes that this is or this isn't.  It isn't black and white, it a sliding scale of atypia.  Different pathologists may have differing opinions for this very reason.  Just so you know, the recommendation for both diagnoses is the same.  Removal with 5mm margins.   So with either diagnosis, extra tissue removal with at least 5mm margins would be recommended. 

No one can say don't worry, but surgical removal should be all that is needed with this lesion.

Pathology is as much an art as a science.  Ideally the slides are being read by a dermatopathologist – a pathologist that specializes in skin pathology.  When a pathologist looks at a slide, there are many factors they look at.  Some factors may indicate cancer, some may be atypical, some may be normal.  They basically weigh all the different indicators and make an educated opinion on whether or not this is melanoma in situ or severely atypical.  There are no absolutes that this is or this isn't.  It isn't black and white, it a sliding scale of atypia.  Different pathologists may have differing opinions for this very reason.  Just so you know, the recommendation for both diagnoses is the same.  Removal with 5mm margins.   So with either diagnosis, extra tissue removal with at least 5mm margins would be recommended. 

No one can say don't worry, but surgical removal should be all that is needed with this lesion.

Pathology is as much an art as a science.  Ideally the slides are being read by a dermatopathologist – a pathologist that specializes in skin pathology.  When a pathologist looks at a slide, there are many factors they look at.  Some factors may indicate cancer, some may be atypical, some may be normal.  They basically weigh all the different indicators and make an educated opinion on whether or not this is melanoma in situ or severely atypical.  There are no absolutes that this is or this isn't.  It isn't black and white, it a sliding scale of atypia.  Different pathologists may have differing opinions for this very reason.  Just so you know, the recommendation for both diagnoses is the same.  Removal with 5mm margins.   So with either diagnosis, extra tissue removal with at least 5mm margins would be recommended. 

No one can say don't worry, but surgical removal should be all that is needed with this lesion.

Superficial spreading melanoma is a type of melanoma.  They most likely are saying that, nothing more.  You are seeing superficial melanoma when they are just specifying the type (there are 5 or 6 different types).  And it is most likely in situ vs severe atypia.  If you have a copy of the pathology report, it would be helpful.

Janner has explained this to me as well, I was recently diagnosed with "severe atypia with a differential diagnosis of malignant melanoma"…..not 'in situ', but 'melanoma'… .8mm level II, stage 1A….. I also wondered, how can this be? Although this is on a broad spectrum of atypia, seems they went right from severe atypia to melanoma, completely skipping 'in situ'……  2 different sets of eyes looking at these slides… 2 path reports…. 2 opinions…. 1 treatment: Surgical excision with margins. Unfortunately my margins were not clear in this last surgery, so now that I'm nice and healed, I have to go back AGAIN and maybe even AGAIN, until they get 'clear margins' That is the goal…. And as long as your son does not have signs of spreading (swllen nodes, or a thickness greater than 1mm, etc) They say there is a slim-to-none chance these cells have migrated to anywhere else in the body…. And of course, me being a 27 yr old female with a 4 yr old son, I need an ABSOLUTE answer…. none of this "slim chance"…. none of this "borderline"…. if I need to do anything else, I want to do it NOW, so I dont sit around oblivious IF I am the unlucky 5%…… But…. what Janner along with others have suggested that I do, if find a melanoma specialist, get a second opinion if I have to, go through with the surgery, and follow up if I have any more issues…. Hard to swallow that, and it takes time to get past the initial panic (im still working on that part!) But in the mean time, educate yourself, ask questions, and be your own advocate. Good luck, and best wishes 🙂

I think you missed my point.  There isn't much difference between the two diagnoses.  And if you were to get another two opinions, you might likely have another "severely atypical" diagnosis and another "melanoma" diagnosis.  THEY ARE VERY CLOSE, there is no black and white diagnosis between the two.  They are treated the same. 

The analysis I've used before is think that 0 is benign and 10 is melanoma in situ.  1-3 is mildly atypical, 4-6 is moderately atypical and 7-9 is severely atypical.  They look at each factor and assign it a value.  One pathologist may thing factor "A" is a 10, another may think it is 8.5.  They look at everything and decide where they think it fits on the scale.  One doctor may say "9" and another says "10".  Very close, but two different final diagnoses.  It's a judgement call between the two and there isn't much difference between the two except one is officially cancer.  I know that doesn't help when you want to know that your son is cancer free but all you can do is ask for other opinions.  See what other pathologists  think and go with a consensus.  But that doesn't change the treatment which is the same in both cases, 5 mm margins.

Janner has done an excellent job addressing the different pathology reports so I want to address your melanoma center and that first visit. U of M is where I go and am very happy there. The first visit will be great for you because you’ll start out with the dermatologist where you’ll probably meet for about an hour. They’ll explain everything and this is also the perfect time for you to address these different pathology reports. My pathology from UofM was a little different than the original as well but like Janners says, treatment is the same either way. After your meeting with the dermatologist, you’ll meet with the surgeon. This may not be as long, but it is PACKED with good info you need to know. All in all, I just want to encourage you that UofM is a great place to be for what your dealing with and I have found them to be great to deal with. If you have questions about U of M feel free to ask, but I think your initial appointment will go a long way in answering your question. Good luck and God Bless!

Janner has done an excellent job addressing the different pathology reports so I want to address your melanoma center and that first visit. U of M is where I go and am very happy there. The first visit will be great for you because you’ll start out with the dermatologist where you’ll probably meet for about an hour. They’ll explain everything and this is also the perfect time for you to address these different pathology reports. My pathology from UofM was a little different than the original as well but like Janners says, treatment is the same either way. After your meeting with the dermatologist, you’ll meet with the surgeon. This may not be as long, but it is PACKED with good info you need to know. All in all, I just want to encourage you that UofM is a great place to be for what your dealing with and I have found them to be great to deal with. If you have questions about U of M feel free to ask, but I think your initial appointment will go a long way in answering your question. Good luck and God Bless!

Janner has done an excellent job addressing the different pathology reports so I want to address your melanoma center and that first visit. U of M is where I go and am very happy there. The first visit will be great for you because you’ll start out with the dermatologist where you’ll probably meet for about an hour. They’ll explain everything and this is also the perfect time for you to address these different pathology reports. My pathology from UofM was a little different than the original as well but like Janners says, treatment is the same either way. After your meeting with the dermatologist, you’ll meet with the surgeon. This may not be as long, but it is PACKED with good info you need to know. All in all, I just want to encourage you that UofM is a great place to be for what your dealing with and I have found them to be great to deal with. If you have questions about U of M feel free to ask, but I think your initial appointment will go a long way in answering your question. Good luck and God Bless!

This previous post should not have been anonymous. It’s me… Thandster

Superficial spreading melanoma is a type of melanoma.  They most likely are saying that, nothing more.  You are seeing superficial melanoma when they are just specifying the type (there are 5 or 6 different types).  And it is most likely in situ vs severe atypia.  If you have a copy of the pathology report, it would be helpful.

Superficial spreading melanoma is a type of melanoma.  They most likely are saying that, nothing more.  You are seeing superficial melanoma when they are just specifying the type (there are 5 or 6 different types).  And it is most likely in situ vs severe atypia.  If you have a copy of the pathology report, it would be helpful.

Janner has explained this to me as well, I was recently diagnosed with "severe atypia with a differential diagnosis of malignant melanoma"…..not 'in situ', but 'melanoma'… .8mm level II, stage 1A….. I also wondered, how can this be? Although this is on a broad spectrum of atypia, seems they went right from severe atypia to melanoma, completely skipping 'in situ'……  2 different sets of eyes looking at these slides… 2 path reports…. 2 opinions…. 1 treatment: Surgical excision with margins. Unfortunately my margins were not clear in this last surgery, so now that I'm nice and healed, I have to go back AGAIN and maybe even AGAIN, until they get 'clear margins' That is the goal…. And as long as your son does not have signs of spreading (swllen nodes, or a thickness greater than 1mm, etc) They say there is a slim-to-none chance these cells have migrated to anywhere else in the body…. And of course, me being a 27 yr old female with a 4 yr old son, I need an ABSOLUTE answer…. none of this "slim chance"…. none of this "borderline"…. if I need to do anything else, I want to do it NOW, so I dont sit around oblivious IF I am the unlucky 5%…… But…. what Janner along with others have suggested that I do, if find a melanoma specialist, get a second opinion if I have to, go through with the surgery, and follow up if I have any more issues…. Hard to swallow that, and it takes time to get past the initial panic (im still working on that part!) But in the mean time, educate yourself, ask questions, and be your own advocate. Good luck, and best wishes 🙂

Janner has explained this to me as well, I was recently diagnosed with "severe atypia with a differential diagnosis of malignant melanoma"…..not 'in situ', but 'melanoma'… .8mm level II, stage 1A….. I also wondered, how can this be? Although this is on a broad spectrum of atypia, seems they went right from severe atypia to melanoma, completely skipping 'in situ'……  2 different sets of eyes looking at these slides… 2 path reports…. 2 opinions…. 1 treatment: Surgical excision with margins. Unfortunately my margins were not clear in this last surgery, so now that I'm nice and healed, I have to go back AGAIN and maybe even AGAIN, until they get 'clear margins' That is the goal…. And as long as your son does not have signs of spreading (swllen nodes, or a thickness greater than 1mm, etc) They say there is a slim-to-none chance these cells have migrated to anywhere else in the body…. And of course, me being a 27 yr old female with a 4 yr old son, I need an ABSOLUTE answer…. none of this "slim chance"…. none of this "borderline"…. if I need to do anything else, I want to do it NOW, so I dont sit around oblivious IF I am the unlucky 5%…… But…. what Janner along with others have suggested that I do, if find a melanoma specialist, get a second opinion if I have to, go through with the surgery, and follow up if I have any more issues…. Hard to swallow that, and it takes time to get past the initial panic (im still working on that part!) But in the mean time, educate yourself, ask questions, and be your own advocate. Good luck, and best wishes 🙂

I think you missed my point.  There isn't much difference between the two diagnoses.  And if you were to get another two opinions, you might likely have another "severely atypical" diagnosis and another "melanoma" diagnosis.  THEY ARE VERY CLOSE, there is no black and white diagnosis between the two.  They are treated the same. 

The analysis I've used before is think that 0 is benign and 10 is melanoma in situ.  1-3 is mildly atypical, 4-6 is moderately atypical and 7-9 is severely atypical.  They look at each factor and assign it a value.  One pathologist may thing factor "A" is a 10, another may think it is 8.5.  They look at everything and decide where they think it fits on the scale.  One doctor may say "9" and another says "10".  Very close, but two different final diagnoses.  It's a judgement call between the two and there isn't much difference between the two except one is officially cancer.  I know that doesn't help when you want to know that your son is cancer free but all you can do is ask for other opinions.  See what other pathologists  think and go with a consensus.  But that doesn't change the treatment which is the same in both cases, 5 mm margins.

I think you missed my point.  There isn't much difference between the two diagnoses.  And if you were to get another two opinions, you might likely have another "severely atypical" diagnosis and another "melanoma" diagnosis.  THEY ARE VERY CLOSE, there is no black and white diagnosis between the two.  They are treated the same. 

The analysis I've used before is think that 0 is benign and 10 is melanoma in situ.  1-3 is mildly atypical, 4-6 is moderately atypical and 7-9 is severely atypical.  They look at each factor and assign it a value.  One pathologist may thing factor "A" is a 10, another may think it is 8.5.  They look at everything and decide where they think it fits on the scale.  One doctor may say "9" and another says "10".  Very close, but two different final diagnoses.  It's a judgement call between the two and there isn't much difference between the two except one is officially cancer.  I know that doesn't help when you want to know that your son is cancer free but all you can do is ask for other opinions.  See what other pathologists  think and go with a consensus.  But that doesn't change the treatment which is the same in both cases, 5 mm margins.

This previous post should not have been anonymous. It’s me… Thandster

This previous post should not have been anonymous. It’s me… Thandster