Biopsy & Testing Questions

I really don't know whether it's OK to just have these lesions bioipsied or if they should be completely excised. I will let others answer that question. I do, however, know a little about pathology, so I will address that. 

All tissue samples are first "fixed" so that they are hard rather than mushy. The traditional way of fixing tissue is to soak them in formaldeyde for a while and then embed them in parafin wax. Once embedded, the pathologist can make very thin sections,  put the sections on a microscope slide and stain the slices with a series of different stains that can help the pathologist determine a diagnosis. This process takes 2 or 3 days.

When you want a second pathology opinion, the first pathologist can send either: 1) the paraffin block, 2) some spare slides that have not yet been stained, or 2) the stained slides. And, of course, the original pathology report.

Some special stains– primarily antibody-based stains, will not work on formaldehyde fixed tissue. In those cases, the surgeon will cut the biopsy specimen in half. He puts one piece in formaldehyde and the other piece he immediately freezes in liquid nitrogen (right in the operating room). Since the frozen tissue is now hard, the pathologist can section it immediately, put the slices on a microscope slide and stain them with the special stain.

When you want a second opinion using a special stain, the pathologist can send either the stained "frozen sections" slides or spare, unstained frozen section slides. The decision to use formaldehyde, frozen sections or both is made before the surgery takes place.

Your profile lists Dr. O'Day at The Angeles Clinic as your primary oncologist. I would ask him what type of slides he needs and the name and address of the pathology lab he uses. Then I would go to the pathology lab in Bangkok IN PERSON to collect the slides and path report and FedEx them to Dr. O'Day's pathology lab in the States.

The "in person" bit will be the hardest part because pathology labs are not used to dealing directly with patients and may be reluctant to hand over the slides to you. You may have to get your Thai surgeon to grease the wheels on that part. But under the circumstances, I would not be comfortable trusting anyone but myself to get those slides and get them to the States in a timely manner.

I really don't know whether it's OK to just have these lesions bioipsied or if they should be completely excised. I will let others answer that question. I do, however, know a little about pathology, so I will address that. 

All tissue samples are first "fixed" so that they are hard rather than mushy. The traditional way of fixing tissue is to soak them in formaldeyde for a while and then embed them in parafin wax. Once embedded, the pathologist can make very thin sections,  put the sections on a microscope slide and stain the slices with a series of different stains that can help the pathologist determine a diagnosis. This process takes 2 or 3 days.

When you want a second pathology opinion, the first pathologist can send either: 1) the paraffin block, 2) some spare slides that have not yet been stained, or 2) the stained slides. And, of course, the original pathology report.

Some special stains– primarily antibody-based stains, will not work on formaldehyde fixed tissue. In those cases, the surgeon will cut the biopsy specimen in half. He puts one piece in formaldehyde and the other piece he immediately freezes in liquid nitrogen (right in the operating room). Since the frozen tissue is now hard, the pathologist can section it immediately, put the slices on a microscope slide and stain them with the special stain.

When you want a second opinion using a special stain, the pathologist can send either the stained "frozen sections" slides or spare, unstained frozen section slides. The decision to use formaldehyde, frozen sections or both is made before the surgery takes place.

Your profile lists Dr. O'Day at The Angeles Clinic as your primary oncologist. I would ask him what type of slides he needs and the name and address of the pathology lab he uses. Then I would go to the pathology lab in Bangkok IN PERSON to collect the slides and path report and FedEx them to Dr. O'Day's pathology lab in the States.

The "in person" bit will be the hardest part because pathology labs are not used to dealing directly with patients and may be reluctant to hand over the slides to you. You may have to get your Thai surgeon to grease the wheels on that part. But under the circumstances, I would not be comfortable trusting anyone but myself to get those slides and get them to the States in a timely manner.

I really don't know whether it's OK to just have these lesions bioipsied or if they should be completely excised. I will let others answer that question. I do, however, know a little about pathology, so I will address that. 

All tissue samples are first "fixed" so that they are hard rather than mushy. The traditional way of fixing tissue is to soak them in formaldeyde for a while and then embed them in parafin wax. Once embedded, the pathologist can make very thin sections,  put the sections on a microscope slide and stain the slices with a series of different stains that can help the pathologist determine a diagnosis. This process takes 2 or 3 days.

When you want a second pathology opinion, the first pathologist can send either: 1) the paraffin block, 2) some spare slides that have not yet been stained, or 2) the stained slides. And, of course, the original pathology report.

Some special stains– primarily antibody-based stains, will not work on formaldehyde fixed tissue. In those cases, the surgeon will cut the biopsy specimen in half. He puts one piece in formaldehyde and the other piece he immediately freezes in liquid nitrogen (right in the operating room). Since the frozen tissue is now hard, the pathologist can section it immediately, put the slices on a microscope slide and stain them with the special stain.

When you want a second opinion using a special stain, the pathologist can send either the stained "frozen sections" slides or spare, unstained frozen section slides. The decision to use formaldehyde, frozen sections or both is made before the surgery takes place.

Your profile lists Dr. O'Day at The Angeles Clinic as your primary oncologist. I would ask him what type of slides he needs and the name and address of the pathology lab he uses. Then I would go to the pathology lab in Bangkok IN PERSON to collect the slides and path report and FedEx them to Dr. O'Day's pathology lab in the States.

The "in person" bit will be the hardest part because pathology labs are not used to dealing directly with patients and may be reluctant to hand over the slides to you. You may have to get your Thai surgeon to grease the wheels on that part. But under the circumstances, I would not be comfortable trusting anyone but myself to get those slides and get them to the States in a timely manner.

The one thought that came to mind is that I would not let them biopsy all three lesions.  I would leave at least one alone.  Then, if for some reason there are issues with the pathology in Thailand, the extra lesion gives you a fallback plan when you get to the states.  If this does turn out to be melanoma and you don't want to leave it, you can have it excised.  But I'd probably only do that after the pathology was confirmed in the US. 

Good luck!

Janner

The one thought that came to mind is that I would not let them biopsy all three lesions.  I would leave at least one alone.  Then, if for some reason there are issues with the pathology in Thailand, the extra lesion gives you a fallback plan when you get to the states.  If this does turn out to be melanoma and you don't want to leave it, you can have it excised.  But I'd probably only do that after the pathology was confirmed in the US. 

Good luck!

Janner

The one thought that came to mind is that I would not let them biopsy all three lesions.  I would leave at least one alone.  Then, if for some reason there are issues with the pathology in Thailand, the extra lesion gives you a fallback plan when you get to the states.  If this does turn out to be melanoma and you don't want to leave it, you can have it excised.  But I'd probably only do that after the pathology was confirmed in the US. 

Good luck!

Janner