Path report help

Forums General Melanoma Community Path report help

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    JC
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      I'm trying to resolve some differences in opinions among path reports (first 2 reports said no mitosis, radial growth phase. .

      I'm trying to resolve some differences in opinions among path reports (first 2 reports said no mitosis, radial growth phase. . next 2 reports said 1 dermal mitotic figure and listed it as <1/mm2 and listed vertical growth phase/tumorigenic), I tried yet again, this time at MD Anderson.  This time 0.34mm, Clark II, radial growth phase present, vertical growth phase present, mitotic figures/mm1 fewer than 1, regression present – focal, TILs non-brisk, then comment says "dermal mitotic figures are not identified."  So, first, I'm not clear on why they list mitotic figure as <1 but then say mitotic figures are not identified.  The other reports only listed <1 because they did identify a mitotic figure (otherwise would be 0).  Something else it says which I don't know what it means is "Anti-PHH3 fails to reveal dermal mitotic figures."  What I'm also confused about is that the other reports that did list VGP as present did so because they identified dermal mitotic figure.  Here, it says dermal mitotic figures are not identified, but yet they still list VGP as present.  I thought the only 2 reasons for listing VGP were either dermal mitosis or dermal nests larger than epidermal nests?  The comment says, "Sections demonstrate an atypical compound melanocytic prolilferation with both nested and single melanocytes along the dermal-epidermal junction with pagetoid upward migration and cytologic atypia. There is focal effacement of rete ridge with underlying dermal fibrosis, inflammatory infiltrate and pigmented macrophages consistent with focal regression. Within the dermis are nests of hyperchromatic, atypical melanocytes which appear histologically similiar to those at the dermal-epidermal junction. These nests are confied to the papillary dermis. Dermal mitotic figures are not identified. There is a small focus of banal appearing less hyperchromatic melanocytes just beneat the associated fibrosis that might represent an associated intradermal nevus."             The other reports also mentioned partial focal regression, but I thought if regression was not a significant part/extensive, then it's ok.  Should I be more concerned about this regression, that it may have actually been deeper than 0.34mm and then regressed?  Or is partial focal regression not considered extensive?  I'm not clear what inflammatory infiltrate and pigmented macrophages mean?  Thanks for any help/clarification out there.

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