› Forums › General Melanoma Community › Pathology report received, borderline melanoma in situ??
- This topic has 18 replies, 3 voices, and was last updated 9 years, 10 months ago by
plb67.
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- May 12, 2016 at 2:00 am
Hi, I'm a 48 year old female and new to this forum. Just had biopsy done last week of suspicious mole and received report. My dermatologist tells me not to be concerned, need excision, but all is superficial and not to worry-as if that's possible 🙂
Can anyone help me with deciphering the report and if I should get a second opinion with an oncologist? Dermatologist says no need to go to oncologist. The surgeon I was referred to made me nervous because they say based on report I would only need 3mm to 5mm margin?
Report says:
Diagnosis: Skin of left posterior shoulder; biopsy consistent with an atypical lentiginous compound nevus associated with basal cell carcinoma of superficial type (see below)
Gross Description:
Received in formalin fixative is a 0.75 x 0.65 x 0.1cm specimen with a pigmented area measuring 0.4 x 0.35cm which appears to go to the margin. The specimen is inked black and bisected for histologic evaluation.
Microscopic Description:
The biopsy specimen revelas acanthosis of the epidermis with junctional nest formation. There is bridging of rete ridges. Increased numbers of melanocytes are evident along the dermal epidermal junction and basaloid tumor with retraction artifact is noted. The histologic findings are consistent with an atypical lentiginous nevus with severe architectural disorder and melanocytic atypia, associated with a basal cell carcinoma of superficial type.
The epidermal changes in some areas are borderline melanoma in situ. Complete excision with careful margin control is advised.
Do I have melanoma-it's not in diagnosis, but in microscopic description? Should I insist larger margins on excision? Should I skip the dermatologist surgeon and go to oncologist?
Any help would be greatly appreciated. Thank you.
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- May 12, 2016 at 2:39 am
I am not an expert on path reports, I am sure others on here that are more versed in reading them will help you decifer what it is saying. I get that the part about it saying "borderline melanoma in situ" is confusing when the rest of the report is saying basal cell. If you want a second opinion then you have to send your biopsy to another dermatopathologist.
An oncologist will have no information for you, oncologists are there for treatment, for later stages when systemic treatment is needed. And, oncologists don't usually deal with basal cell because it is incredibly rare for basal cell to spread past the primary tumor site.
I had 2 different dermatopathologists look at my biopsy when I had it done, just to be sure about the diagnosis from the biopsy, so, getting a second opinion is not unusual.
I don't think you would need wider margins than what they are suggesting, whether basal cell or melanoma in situ, it is superficial which means it is only on the top layer of your epidermis (skin) and has not gotten to the next layers that are connected with blood and lymph vessels. If they do 5mm, that's 0.5cm which is in the range of what they'd do for melanoma in situ (0.5cm-1cm). You can ask them to err on the side of wider if it makes you feel better. More than likely, based on your path report and my own small bit of knowledge, I believe it is basal cell (my dad has had many of these), you don't need huge margins for basal cell and it's not something to worry about.
All the best,
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- May 12, 2016 at 2:39 am
I am not an expert on path reports, I am sure others on here that are more versed in reading them will help you decifer what it is saying. I get that the part about it saying "borderline melanoma in situ" is confusing when the rest of the report is saying basal cell. If you want a second opinion then you have to send your biopsy to another dermatopathologist.
An oncologist will have no information for you, oncologists are there for treatment, for later stages when systemic treatment is needed. And, oncologists don't usually deal with basal cell because it is incredibly rare for basal cell to spread past the primary tumor site.
I had 2 different dermatopathologists look at my biopsy when I had it done, just to be sure about the diagnosis from the biopsy, so, getting a second opinion is not unusual.
I don't think you would need wider margins than what they are suggesting, whether basal cell or melanoma in situ, it is superficial which means it is only on the top layer of your epidermis (skin) and has not gotten to the next layers that are connected with blood and lymph vessels. If they do 5mm, that's 0.5cm which is in the range of what they'd do for melanoma in situ (0.5cm-1cm). You can ask them to err on the side of wider if it makes you feel better. More than likely, based on your path report and my own small bit of knowledge, I believe it is basal cell (my dad has had many of these), you don't need huge margins for basal cell and it's not something to worry about.
All the best,
-
- May 12, 2016 at 2:39 am
I am not an expert on path reports, I am sure others on here that are more versed in reading them will help you decifer what it is saying. I get that the part about it saying "borderline melanoma in situ" is confusing when the rest of the report is saying basal cell. If you want a second opinion then you have to send your biopsy to another dermatopathologist.
An oncologist will have no information for you, oncologists are there for treatment, for later stages when systemic treatment is needed. And, oncologists don't usually deal with basal cell because it is incredibly rare for basal cell to spread past the primary tumor site.
I had 2 different dermatopathologists look at my biopsy when I had it done, just to be sure about the diagnosis from the biopsy, so, getting a second opinion is not unusual.
I don't think you would need wider margins than what they are suggesting, whether basal cell or melanoma in situ, it is superficial which means it is only on the top layer of your epidermis (skin) and has not gotten to the next layers that are connected with blood and lymph vessels. If they do 5mm, that's 0.5cm which is in the range of what they'd do for melanoma in situ (0.5cm-1cm). You can ask them to err on the side of wider if it makes you feel better. More than likely, based on your path report and my own small bit of knowledge, I believe it is basal cell (my dad has had many of these), you don't need huge margins for basal cell and it's not something to worry about.
All the best,
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- May 12, 2016 at 3:38 am
You have a severely atypical mole that is not diagnosed as melanoma, only atypical. The cancer diagnosis Is basal cell carcinoma, but that is an entirely different cell type. You can have both cell types in the same area. Basal cell requires clean margins only. Severely atypical lesions are typically excised with 5mm margins. These are the same margins they use for melanoma in situ. This is purely precautionary. Because of both cell types and the indication of severely atypical lentiginous lesion, I'd ask for the 5mm margins. Your original margins were not clear and I'd err on a larger excision to be cautious. No oncologist would see you for this but you can get a second opinion on the pathology. However, if you do the 5mm margins, you are treating this as you would melanoma in situ. It's much better not to have a melanoma diagnosis so the margins give you the insurance policy with a better diagnosis.
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- May 12, 2016 at 3:38 am
You have a severely atypical mole that is not diagnosed as melanoma, only atypical. The cancer diagnosis Is basal cell carcinoma, but that is an entirely different cell type. You can have both cell types in the same area. Basal cell requires clean margins only. Severely atypical lesions are typically excised with 5mm margins. These are the same margins they use for melanoma in situ. This is purely precautionary. Because of both cell types and the indication of severely atypical lentiginous lesion, I'd ask for the 5mm margins. Your original margins were not clear and I'd err on a larger excision to be cautious. No oncologist would see you for this but you can get a second opinion on the pathology. However, if you do the 5mm margins, you are treating this as you would melanoma in situ. It's much better not to have a melanoma diagnosis so the margins give you the insurance policy with a better diagnosis.
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- May 12, 2016 at 12:24 pm
Can a severely atypical lesion change to become melanoma? Yes. Does it always? No. There is no way to know if the Nevus portion was stable or evolving. Certainly the basal cell carcinoma was changing as that is most likely what you noticed. This seems to be fairly unusual but you've had it removed and will have wider margins. Afterward, you just watch the scar area for any pigment regrowth or changes not related to healing. If something unusual shows up, see your derm.
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- May 12, 2016 at 12:24 pm
Can a severely atypical lesion change to become melanoma? Yes. Does it always? No. There is no way to know if the Nevus portion was stable or evolving. Certainly the basal cell carcinoma was changing as that is most likely what you noticed. This seems to be fairly unusual but you've had it removed and will have wider margins. Afterward, you just watch the scar area for any pigment regrowth or changes not related to healing. If something unusual shows up, see your derm.
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- May 12, 2016 at 12:24 pm
Can a severely atypical lesion change to become melanoma? Yes. Does it always? No. There is no way to know if the Nevus portion was stable or evolving. Certainly the basal cell carcinoma was changing as that is most likely what you noticed. This seems to be fairly unusual but you've had it removed and will have wider margins. Afterward, you just watch the scar area for any pigment regrowth or changes not related to healing. If something unusual shows up, see your derm.
-
- May 12, 2016 at 3:38 am
You have a severely atypical mole that is not diagnosed as melanoma, only atypical. The cancer diagnosis Is basal cell carcinoma, but that is an entirely different cell type. You can have both cell types in the same area. Basal cell requires clean margins only. Severely atypical lesions are typically excised with 5mm margins. These are the same margins they use for melanoma in situ. This is purely precautionary. Because of both cell types and the indication of severely atypical lentiginous lesion, I'd ask for the 5mm margins. Your original margins were not clear and I'd err on a larger excision to be cautious. No oncologist would see you for this but you can get a second opinion on the pathology. However, if you do the 5mm margins, you are treating this as you would melanoma in situ. It's much better not to have a melanoma diagnosis so the margins give you the insurance policy with a better diagnosis.
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Tagged: cutaneous melanoma
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