pathdoc

yes, pathologist

yes, pathologist

yes, pathologist

Prognosis is great for early lesions.  But not perfect, very unfortunately so.

Recent patient who I had signed as In situ melanoma with rare possible single cells of superficial invasion (Stage 0 vs early IA, 2.5 yrs ago).  Received appropriate wide excision with no additional disease seen.  Now with large axillary node.  Initial core biopsy of node for of brown pigment but no tumor cells seen. Excision of node is now recommended for full evaluation as this is still highly suspicious. The patient has had previous melanoma in situ diagnosed else where as well as reported long history of biopsies of several other "atypical melanocytic nevi"…. 

The absolute predictability of the behavior of these is an impossibility.

All practioners want to do the right thing for their patients.  I know I personally agonize over this.  I see over 10,000 skin biopsies a year.  Most fortunately are very straight forward.  The opposite challenge of this is over calling melanocytic lesions with not only the potential for morbidity of additional procedure but also as this board is testament too… the anxiety that may come with a Melanoma diagnosis at any stage. (Especially if over called or over staged.)

Melanomas don't read text books or journal articles or survival curves.

I give all of you who carry this diagnosis, my hopes and prayers for the best possible outcomes.

Prognosis is great for early lesions.  But not perfect, very unfortunately so.

Recent patient who I had signed as In situ melanoma with rare possible single cells of superficial invasion (Stage 0 vs early IA, 2.5 yrs ago).  Received appropriate wide excision with no additional disease seen.  Now with large axillary node.  Initial core biopsy of node for of brown pigment but no tumor cells seen. Excision of node is now recommended for full evaluation as this is still highly suspicious. The patient has had previous melanoma in situ diagnosed else where as well as reported long history of biopsies of several other "atypical melanocytic nevi"…. 

The absolute predictability of the behavior of these is an impossibility.

All practioners want to do the right thing for their patients.  I know I personally agonize over this.  I see over 10,000 skin biopsies a year.  Most fortunately are very straight forward.  The opposite challenge of this is over calling melanocytic lesions with not only the potential for morbidity of additional procedure but also as this board is testament too… the anxiety that may come with a Melanoma diagnosis at any stage. (Especially if over called or over staged.)

Melanomas don't read text books or journal articles or survival curves.

I give all of you who carry this diagnosis, my hopes and prayers for the best possible outcomes.

Prognosis is great for early lesions.  But not perfect, very unfortunately so.

Recent patient who I had signed as In situ melanoma with rare possible single cells of superficial invasion (Stage 0 vs early IA, 2.5 yrs ago).  Received appropriate wide excision with no additional disease seen.  Now with large axillary node.  Initial core biopsy of node for of brown pigment but no tumor cells seen. Excision of node is now recommended for full evaluation as this is still highly suspicious. The patient has had previous melanoma in situ diagnosed else where as well as reported long history of biopsies of several other "atypical melanocytic nevi"…. 

The absolute predictability of the behavior of these is an impossibility.

All practioners want to do the right thing for their patients.  I know I personally agonize over this.  I see over 10,000 skin biopsies a year.  Most fortunately are very straight forward.  The opposite challenge of this is over calling melanocytic lesions with not only the potential for morbidity of additional procedure but also as this board is testament too… the anxiety that may come with a Melanoma diagnosis at any stage. (Especially if over called or over staged.)

Melanomas don't read text books or journal articles or survival curves.

I give all of you who carry this diagnosis, my hopes and prayers for the best possible outcomes.