Help with Pathology Report

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  • Post
    • April 19, 2014 at 4:14 pm
    Ajones1123
    Participant

      Hi all,

      My mother is going in for a wider excision on Monday for an atypical mole she had removed.  I know there is a TON of knowledge on this board and many of you are extremely educated when it comes to how to interpret pathology, etc.  I just want to know if anything looks extremely alarming on her path report and if conservative excision is appropriate.  The report is as follows:

      Diagnosis: Compound Nevus with moderate to focally severe atypia

      Microscopic description:

      Left Calf: Sections show a proliferation of somewhat spindled melanocytes that are arranged in nests and as single units with a confluent pattern of growth mostly within the lower portion of the epidermis. Nested melanocytes are irregularly distributed in the lower portion of the epidermis, and nests bridge between adjacent rete ridges in areas.  The melanocytes display moderate cytologic atypia, including variation in nuclear enlargement and staining intensity, mostly at the dermoepidermal junction.  The superficial dermis shows nests and strands of similar appearing melanocytes. Additional dermal changes include fibroplasia, variable mononuclear cell inflammation, and scattered melanophages.  Scattered melanocytes also demonstrate variable degrees of cytoplasmic pigmentation. The immunostain for Melan-A shows a brisk junctional proliferation of atypical melanocytes with confluent growth pattern accompanied by a subtle limited pagetoid scatter above the dermoepidermal junction. It also highlights nevomelanocytes in the dermis.  These findings represent a compound nevus with moderate to focally severe architectural and moderate cytological atypia. 

      Comment: while the specimen margins are free in the planes of sections examined, the distance to the peripheral edge is only about a millimeter, and conservative re-excision is recommended to ensure complete lesion removal if clinically warranted.

      Thanks in advance to anyone who has any input on the report.  Is this just basically an atypical nevus (closer to the moderate end of the spectrum)?  Is conservative re-excision appropriate?  Thanks again!

       

      April

       

    Viewing 2 reply threads
    • Replies
        • April 19, 2014 at 9:57 pm
        Janner
        Participant

          Definitely, I would do the re-excision.  As to what the margins are for "conservative", that seems to vary by doc.  But I'd like to have a couple of millimeters free and clear if it were me.  Better safe than sorry!

          • April 19, 2014 at 9:57 pm
          Janner
          Participant

            Definitely, I would do the re-excision.  As to what the margins are for "conservative", that seems to vary by doc.  But I'd like to have a couple of millimeters free and clear if it were me.  Better safe than sorry!

              • April 20, 2014 at 12:06 am
              Ajones1123
              Participant

                Thanks Janner.  Does anything jump out as being particularly sinister about this lesion, or does it just sound like a pretty cut and dry dysplastic nevus?  She's definitely going to do the re-excision Monday.  It was actually removed in November, but due to insurance issues, she is just now getting around to the re-excision. Do you think the passage of time will create an issue?  Her doc didn't seem to think it would be a problem.  Thanks again.

                • April 20, 2014 at 12:06 am
                Ajones1123
                Participant

                  Thanks Janner.  Does anything jump out as being particularly sinister about this lesion, or does it just sound like a pretty cut and dry dysplastic nevus?  She's definitely going to do the re-excision Monday.  It was actually removed in November, but due to insurance issues, she is just now getting around to the re-excision. Do you think the passage of time will create an issue?  Her doc didn't seem to think it would be a problem.  Thanks again.

                  • April 20, 2014 at 12:25 am
                  Janner
                  Participant

                    Nothing jumped out at me – it's just prudent.  I don't think the time issue is important.  Even with melanoma, the timing after the biopsy doesn't seem to affect prognosis (statistically, not emotionally).

                    • April 20, 2014 at 12:25 am
                    Janner
                    Participant

                      Nothing jumped out at me – it's just prudent.  I don't think the time issue is important.  Even with melanoma, the timing after the biopsy doesn't seem to affect prognosis (statistically, not emotionally).

                      • April 20, 2014 at 12:44 am
                      Ajones1123
                      Participant

                        Thanks again for your input.  I think my health anxiety is probably more the issue rather than her atypical nevus lol.  Of course I google every little word to try and decipher what it all means.  I've read many posts where you've offered advice and just want to say thanks so much for your time.  I know you've helped many people on this forum.  Thanks again!

                        • April 20, 2014 at 12:44 am
                        Ajones1123
                        Participant

                          Thanks again for your input.  I think my health anxiety is probably more the issue rather than her atypical nevus lol.  Of course I google every little word to try and decipher what it all means.  I've read many posts where you've offered advice and just want to say thanks so much for your time.  I know you've helped many people on this forum.  Thanks again!

                          • April 20, 2014 at 12:44 am
                          Ajones1123
                          Participant

                            Thanks again for your input.  I think my health anxiety is probably more the issue rather than her atypical nevus lol.  Of course I google every little word to try and decipher what it all means.  I've read many posts where you've offered advice and just want to say thanks so much for your time.  I know you've helped many people on this forum.  Thanks again!

                            • April 20, 2014 at 12:25 am
                            Janner
                            Participant

                              Nothing jumped out at me – it's just prudent.  I don't think the time issue is important.  Even with melanoma, the timing after the biopsy doesn't seem to affect prognosis (statistically, not emotionally).

                              • April 20, 2014 at 12:06 am
                              Ajones1123
                              Participant

                                Thanks Janner.  Does anything jump out as being particularly sinister about this lesion, or does it just sound like a pretty cut and dry dysplastic nevus?  She's definitely going to do the re-excision Monday.  It was actually removed in November, but due to insurance issues, she is just now getting around to the re-excision. Do you think the passage of time will create an issue?  Her doc didn't seem to think it would be a problem.  Thanks again.

                              • April 19, 2014 at 9:57 pm
                              Janner
                              Participant

                                Definitely, I would do the re-excision.  As to what the margins are for "conservative", that seems to vary by doc.  But I'd like to have a couple of millimeters free and clear if it were me.  Better safe than sorry!

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