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New here, can someone help me with this pathology report? Janner/regs

New here, can someone help me with this pathology report? Janner/regs

Posted By
nyalt
3/31/2011 4:40pm
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Replies: 11

Hello, I'm new here. Was instructed by someone on another message board to come here, post my report, and ask for "Regs or Janner".  Thanks in advance to all for your thoughts and advice, it is appreciated.

I had a small mole removed recently, after the pathology report came back the dermatologist said we needed to do further excision.  This is the first mole I've had removed with any suspicious findings.  Basically, the findings are equivocal, they say that they cannot exclude melanoma and report recommends conservative re-excision. This has already been scheduled, basically I need to know what questions to ask.

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DX: Lentiginous compound nevus dysplastic type with severe dysplasia, extending to all the margins with postinflammatory pigmentary alteration. Conservative re-excision is advised.  Comment: Pagetoid extension of melanocytes are seen. Special stains are pending.

Tissue measured 0.3x0.3cm in greatest dimension. Entire specimen submitted in one cassette.

Dermoepidermal junction contains a primarily nested melanocytic proliferation. Within the superficial dermis, discrete nests of melanocytes with slightly smaller nuclei are present. lateral to the dermal portion of the lesion moderately atypical melanocytes proliferate which bridge and fuse adjacent rete and are associated with a superficial fibrosis of the papillary dermis.  There is a proflieration of solitary melanocytes at the dermal-epidermal junction. In the superficial dermis, melanophages and scattered mononuclear cells surround capillaries.

Immunohistochemical studies reveal with anti-melan-A stain, a diffuse melanocytic hyperplasia with focal pagetoid extension of melanocytes.

Comment: it is difficult to exclude an early, evolving malignant melanoma in situ, superficial spreading type, arising in association with compound nevus dysplastic type with severe dysplasia, extending to all the margins.

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The pathology analysis was done by dermatopathologists, reviewed by a fellow as well as intradepartmental review session (all from a teaching hospital in NYC). All agreed on report.
 

My question is -- what stands out for you? what should I be asking my doctor? In the NYC area who should I ask for a 2nd opinion from?  what will they be able to tell from this larger excision, if anything? if they still can't tell if it's melanoma, then what?  Also, I'm in my mid-late 30s, female, if that's of use to know.

I also wanted to add that the report said

"specimen received in formalin" -- I'm not sure that matters

 

Thanks again.

What I would ask is the following:

I understand that this isn't melanoma but a severe dysplastic (atypical) mole but does this mean that am I at a higher than normal risk for melanoma? are there any other moles on my body that should be checked out or even biopsied? should I be followed on a regular basis by a dermatologist?

Melanoma can be genetic or it can be brought on by the sun or it can be hormonal (although alot more studies need to be done to confirm this). And alot of times, melanoma can strike with no known risk factors. If you are prone to having odd shaped moles, you need to be careful. From what is known, atypical moles can be a precursor to melanoma.

You were VERY lucky this time. Count your blessings, be safe, and be aware of any changes that may occur with your beauty marks or anything new that pops up.

The only real wisdom is knowing you know nothing -Socrates

Thank you for your reply.

I'm most concerned b/c from what I've read so far the description from my report matches the description of melanoma, and my doctor was very clear to state that:

we cannot say it isn't melanoma, they are not sure if it is, and this needs to be removed very quickly.

The irony here is that except for sun exposure as a child, I have always avoided the sun, and been a big user of sunscreen and staying in the shade.  No family history of this that I know of.  I have been getting regular skin checks by a derm each year.   Thanks again for your response!

I  am on my 2 nd atypical mole i go the 20 th of april to have more out. i know im high risk my mom is a stage 4 and my grandma had mm, im thankful i go for yearly checks , im a stage 1 breast cancer. also had a colon polup pre cancerous, so early prevention has saved my life

 

Maybe it was caught at that perfect point where it was going from severly dysplastic to a insitu melanoma.

At any rate, it seems that they are treating it as a insitu melanoma, and proper procedure is being followed.

Even if it is insitu and not dysplastic, insitu carries a 100% 5 and 10 year survival.

So, I am going to congratulate you for catching this early!

Michael-stage 1b

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

Oh, and "specimen received in formalin" means the tumor sample was recieved (shipped) in a solution of formaldehyde.

It does not affect your diagnosis.

Michael

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

Michael, thank you for your interpretation of the path report.  I'm not sure if I'd feel better if the report had been able to say 100% whether it is a dysplastic nevus or m-in situ, but am reassured that the recommended procedure is the same for both scenarios.

 

thank you!

It does sound like the dermatopathologist is on the fence as to calling it severely dysplastic or insitu.

As Jan said, for future insurance purposes-insitu means melanoma. If you do get a second opinion and they say melanoma to cover themselves, it very well may affect your future life and health insurance options. As was already discussed on the board, the medical procedure is the same though, and no other treatment will be needed after the WLE (wide local excision) other than derm visits and watching yourself for "change", so it seems everything is covered.

Michael-stage 1b with two melanomas and one moderately dysplastic nevus.

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

I think "Regs" meant the regulars here.  I think the others have answered your basic questions.  I'm going to touch on something a little different.

You know you have a lesion that is currently labeled severely atypical.  In is not a melanoma diagnosis.  If the lesion were melanoma, it would be labeled melanoma in situ.  The treatment for both severely atypical lesions and melanoma in situ is to obtain 5mm margins.  Identical treatments for different diagnoses.  This isn't an issue that the pathologist can't tell if it is melanoma or not, this is an issue of degrees.  Think of a mole on a scale of 1-10.  1 is benign.  10 is melanoma in situ.  Maybe the pagetoid features say your lesion is a 10, but the smaller nuclei are a 7 on the "atypical" scale.  After looking at many different factors, the pathologist says overall, this lesion doesn't meet enough criteria in his/her mind to be melanoma.  Over time, this lesion might have become melanoma.  However, it is also possible it might not have.

Here's the bottom line in my opinion.  It is so much better, insurance wise, to have an atypical lesion and NOT cancer/melanoma.  Any life insurance forms, health insurance, etc. will ask you if you've had cancer.  Melanoma is one of those cancers that can screw you out of insurance years later.  Severely atypical lesions are not cancer, therefore you can answer truthfully that you haven't had cancer.  Reading pathology is as much an art as a science.  If you send your slides off to another dermatopathologist, they might say they think this lesion is melanoma in situ. They will recommend getting the same 5mm margins (identical treatment), and now you will have a history of melanoma.  There is some discussion that melanoma is overdiagnosed at this very early stage - to basically cover the dermatopathologists butt. 

Certainly, you can get a second opinion.  But you're in a major city and it's likely that the dermpaths who read your slides are versed in melanoma.  (You can't always say that in smaller towns -- and you can research the pathologist to see their credentials).  But I just want to point out that getting a second opinion could have consequences that are more far reaching than you might expect.

Best wishes,

Janner

Janner, thank you for your detailed & clearly well thought out response.  I really, really appreciate it. And yes, I think 'regs' meant regulars - the person who referred me is from an anonymous board. I assume the 2nd excision will be sent to the dermatopathology lab as well.  And I am feeling more confident today about the 2nd excision. I had been so focused on the report that I hadn't really thought about how it is same recommended treatment for either Dx.  Nor had I really considered the CYA (cover your a**) possibility of an M-in-situ diagnosis. Thank you again for your response.

Thank you to all for helping sort this out.

I will post back when I have the 2nd results.

I wanted to post back and thank you all for your thoughts on the pathology report and my questions on what I should ask.  I had the WLE and the 2nd path report came back clear.  My doctor said that I would need follow up frequently over the next few years.  So thank you all!