› Forums › General Melanoma Community › Your thoughts on this pathology report . . . .
- This topic has 6 replies, 2 voices, and was last updated 13 years, 4 months ago by
Janner.
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- May 3, 2011 at 2:00 pm
Here is my SIL's pathology report:
Skin, left leg lesion: Melanoma in situ
Comment: It is not known if this is a biopsy of a larger lesion or an excisional biopsy. Due to small size, fragmentation and orientation, the margins cannot be adequately evaluated.
Skin, Left Leg Lesion: Received and labeled “lesion L leg,” is a .2 cm portion of dark brown-gray tissue that is submitted as received along with a smaller minute fragment.
Clinical info or preop diag: None given
Here is my SIL's pathology report:
Skin, left leg lesion: Melanoma in situ
Comment: It is not known if this is a biopsy of a larger lesion or an excisional biopsy. Due to small size, fragmentation and orientation, the margins cannot be adequately evaluated.
Skin, Left Leg Lesion: Received and labeled “lesion L leg,” is a .2 cm portion of dark brown-gray tissue that is submitted as received along with a smaller minute fragment.
Clinical info or preop diag: None given
Microscopic Description: The sections consist of levels of two tiny fragments of skin with a melanocytic lesion. There is a lentigenous melanocytic proliferation; focally the melanocytic cells are see in the superficial portions of the epidermis. Cytologic atypia is mild to moderate. No mitoses are seen. A few lymphocytes are seen in the underlying dermis. Fragmentation and orientation preclude evaluation of the margins.
**any misspellings are most likely mine! 🙂
This is the pathology report that caused the general practitioner to want to do a punch biopsy before a full excision. Instead, my SIL asked to be referred to an oncologist and now has an appointment scheduled for tomorrow (Wednesday) with the oncologist, who may want to do the exact same thing, but will at least know what he is doing or send her to someone who does. Also, she has an infection in the wound caused by the shave biopsy, and was given an oral antibiotic for the infection.
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- May 3, 2011 at 5:19 pm
It's a little hard to interpret. The microscopic findings only mention mild to moderate atypia while the diagnosis says in situ. Seems a little strange not to have more atypia with an in situ diagnosis but I'm sure it could happen. The shave biopsy was too tiny to give much more information such as margines, etc. – definitely the doctor's fault there. I think it is best that your SIL will see a specialist and someone who can better evaluate her situation. They may also want to see the original path slides for their own evaluation. Make sure she takes the path report with her to the visit. Is the oncologist she is seeing a melanoma oncologist? She really may not need an oncologist if the diagnosis is in situ, but she definitely needs a good dermatologist. And she needs to avoid biopsies from PCPs in the future if they can't do a better job than a tiny shave.
Best wishes to your SIL on this lesion!
Janner
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- May 4, 2011 at 8:34 am
Thanks, Janner! She is on her way to see an oncologist with melanoma background, but not a specialist. There is an excellent dermatologist with melanoma experience associated with the oncologist's cancer center.
Also, what would you make of this–my SIL clearly saw 4 pieces of skin in the container when they did her shave biopsy. On the day she picked up her path report the doctor made a comment that she had done two biopsies in a 24 hour period that both came back as melanoma and felt that the situation was highly unusual. I'm naturally a little paranoid so I'm thinking maybe the samples were switched or mislabeled. If the two unmentioned pieces of skin were too small to do anything with, wouldn't the report still say that they were present?
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- May 4, 2011 at 12:02 pm
I'm sure different labs may handle things differently. I would expect the report to mention the other bits of skin, but if they were tiny and unusuable, maybe not. It's possible things were switched, it's been known to happen. But truthfully, it's better to proceed with the worst case scenario to avoid problems later on. The rest of the lesion can still be evaluated and she goes from there. Hopefully, the onc is better versed than the PCP and can manage things correctly for your SIL.
Best wishes,
Janner
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- May 4, 2011 at 12:02 pm
I'm sure different labs may handle things differently. I would expect the report to mention the other bits of skin, but if they were tiny and unusuable, maybe not. It's possible things were switched, it's been known to happen. But truthfully, it's better to proceed with the worst case scenario to avoid problems later on. The rest of the lesion can still be evaluated and she goes from there. Hopefully, the onc is better versed than the PCP and can manage things correctly for your SIL.
Best wishes,
Janner
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- May 4, 2011 at 8:34 am
Thanks, Janner! She is on her way to see an oncologist with melanoma background, but not a specialist. There is an excellent dermatologist with melanoma experience associated with the oncologist's cancer center.
Also, what would you make of this–my SIL clearly saw 4 pieces of skin in the container when they did her shave biopsy. On the day she picked up her path report the doctor made a comment that she had done two biopsies in a 24 hour period that both came back as melanoma and felt that the situation was highly unusual. I'm naturally a little paranoid so I'm thinking maybe the samples were switched or mislabeled. If the two unmentioned pieces of skin were too small to do anything with, wouldn't the report still say that they were present?
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- May 3, 2011 at 5:19 pm
It's a little hard to interpret. The microscopic findings only mention mild to moderate atypia while the diagnosis says in situ. Seems a little strange not to have more atypia with an in situ diagnosis but I'm sure it could happen. The shave biopsy was too tiny to give much more information such as margines, etc. – definitely the doctor's fault there. I think it is best that your SIL will see a specialist and someone who can better evaluate her situation. They may also want to see the original path slides for their own evaluation. Make sure she takes the path report with her to the visit. Is the oncologist she is seeing a melanoma oncologist? She really may not need an oncologist if the diagnosis is in situ, but she definitely needs a good dermatologist. And she needs to avoid biopsies from PCPs in the future if they can't do a better job than a tiny shave.
Best wishes to your SIL on this lesion!
Janner
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