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understanding my report

understanding my report

Posted By
1/7/2019 5:24pm
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Replies: 2

Hi everyone,

I had a punch biopsy done on [part of my mole] on my face. The mole itself is about the size of a pencil eraser.  The punch biopsy  was 0.3 cmx0.3 cmx0.3 cm, which took out all of the "dark" part of the mole. It's the healthy [looking] part of the mole that remains. I'm not understanding all of the scientific description below.  I understand in situ to be a low risk lesion  to likely not spread- is that correct?  How often does in situ's ...upstage after my wide local re-excision?  Anyone know how big the scar is going to be?


Diagnosis: Punch Biopsy: Melanoma in Situ (face, cheek).

Recommendation: Wide local re-excision (5mm margin) scheduled next week.

- punch biopsy shows presence of an atypical junctional melanocytic lesion characterized by occasional nests of atypical melanocytes along the base of the epidermis with the long axis parallel to hte epidermal surface as well as single melanocytes with atypical cytological features extending into the upper portions of the epidermis as well as focally showing a confluent growth patter along the basal layer.
There is involvement of follicular epithelium. There are melanophages in the superficial dermis as well as mild perivascular chronic inflammation. There is absence of an intradermal melanocytic omponent in the punch biopsy. There is minimal dermal solar elastosis. The lesion extends to and is present in the peripheral borders of the punch biopsy. The specimen is 0.3cm x 0.3 cmx 0.3 cm in depth.


Janner - (1/8/2019 - 11:19am)

Typically we recommend than the entire lesion be removed when biopsied.  But given this was on your face, I understand the rationale of doing a partial biopsy.  In general, you'd expect the deepest portion to be located in the most concerning area.  But there is no way to know that for certain.  So we can't speculate on the WLE and any possible upstaging when the majority of the lesion wasn't removed. 

The scientific description is of little value to piece word by word.  It basically justifies the diagnosis.  The important part is melanoma in situ.  In the melanoma world, that's what you want to see.  As for the scar, it depends on a lot of things.  Location, tightniess, basic anatomy.  The face covers a lot of area.  In general, to get 5mm margins, you start at the biopsy site and scribe a 1cm circle - 5mm all around the center lesion.  But then on two sides, you lengthen the area to make an ellipse.  The length needed is generally 3 times the width so you can close a wound without a pucker.  That's a basic guideline because it all depends on where the lesion is located, skin movement, tightness, things like that.  Is the surgeon a plastic surgeon?  Someone who does a lot of facial reconstruction?  I'd just make sure the surgeon is well qualified and hopefully everything will go just fine with no deeper component and scaring minimal.

canadagirl - (1/10/2019 - 1:39pm)

Hi  Janner,

Thanks so much for you reply! 

Surgery is Monday!