newly diagnosed – the lab report

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  • Post
    • September 5, 2014 at 8:06 pm
    lactansdea
    Participant

      Hi, hoping someone can translate for me:

       

      Large melanocytic lesion with prominent proliferation of nests and single atypical melanocytes along the dermal epidermal junction in a lentiginous patter.  the cells have large atypical nuclei and there is focul upward migration of single melanocytes as well as melanin pigment in the cells.  The papillary dermins shows fibroplasia with an area of regression noted as there is fibrosis, increased number of vessels, scattered inflammation and melanophages.  There is also some invasion of the papillary dermis by nests of atypical melanocytic cells and there is a distinction between the atypical melanocytes inflitrating the papillary dermis and deeper nests of nevus cells which have a benign appearance so this melanoma appaers to have developed in a pre-existent dysplastic nevus.  The melanocytes have somewhat nevoid appearance, but there is a large nucleolus in each cell and lack of maturation with an occasional mitotic figure seen.  The overall appearance there is that of a malignant melanoma developing in a dysplactic nevus, level 3 invasion.  The vertical height is 0.70 mm with no ulceration and focal regression is noted.  The melanocytes are extending very close to one lateral margin of the biopsy so the lesion is not completely excised.  the mitotic index is two mistoses per one mm squared.

       

      Thanks!

      newbie

    Viewing 2 reply threads
    • Replies
        • September 5, 2014 at 8:42 pm
        Janner
        Participant

          Basically the first part justifies the diagnosis.  Line by line analysis isn't all that helpful.  The key points are a depth of 0.7mm, no ulceration, focal regression and 2 mitosis. This is a stage 1b lesion.  You will need a WLE (wide local excision) and you will need to discuss with your doc the possibility of a sentinel node biopsy.  (Some will say yes, others no).  It is a low risk (not no risk) lesion and hopefully gone forever once the WLE is done.  The depth is 0.7mm.  Ideally there would be no depth.  No ulceration is good.  Focal regression is a mixed bag.  Some see it as positive and some negative.  Basically, the body recognized a problem and started destroying it in one localized area. Good in theory, but the fibrosis could hide a lesion that was a little deeper at one point.  Since this is only focalized regression (minimal), I tend to think little info is lost and it's a reasonably good sign.  Mitosis would ideally be <1.  This shows the number of cells seen dividing in a specific area.  Less is better.

            • September 5, 2014 at 8:51 pm
            lactansdea
            Participant

              thanks….can i assume it is gone forever if a WLE comes back with clean margins? what determines risk after a WLE?

              • September 5, 2014 at 9:08 pm
              Janner
              Participant

                You can't assume anything.  Unfortunately, melanoma can come back years after lying dormant.  Yes, the majority of folks in your situation never deal with it again.  But some do.  So it is best to be vigilant, watch for regrowth, watch other moles for change (new primaries).  Learn to palpate your lymph node basins.  I am also stage 1b and was originally diagnosed in 1992.  Long time survivor with no recurrence.  On a site like this, you will find more "exceptions".  People who had a recurrence are more likely to show up here than people who've gone years without one so the site itself is a skewed population and not representative of the actual melanoma population.  Most likely for you, the WLE will be curative.  But be aware that the WLE isn't a guarantee so be watchful in the future.  Depth is the #1 risk, the thinner the better.  

                • September 6, 2014 at 1:41 pm
                lactansdea
                Participant

                  Question: does the fact that no microscopic sattelites were seen and no lymphatic invasion mead that it's less likely that there is a rogue cell on it's way throughout my body?

                  Also, does the "melanocytes are extending very close" necessarily mean they didn't get it all, or just that there isn't SUFFICIENT clean margin seen?

                  When you DO get clean margins, are you "cured" pending recurrence?

                  thanks

                  • September 6, 2014 at 1:41 pm
                  lactansdea
                  Participant

                    Question: does the fact that no microscopic sattelites were seen and no lymphatic invasion mead that it's less likely that there is a rogue cell on it's way throughout my body?

                    Also, does the "melanocytes are extending very close" necessarily mean they didn't get it all, or just that there isn't SUFFICIENT clean margin seen?

                    When you DO get clean margins, are you "cured" pending recurrence?

                    thanks

                    • September 6, 2014 at 1:41 pm
                    lactansdea
                    Participant

                      Question: does the fact that no microscopic sattelites were seen and no lymphatic invasion mead that it's less likely that there is a rogue cell on it's way throughout my body?

                      Also, does the "melanocytes are extending very close" necessarily mean they didn't get it all, or just that there isn't SUFFICIENT clean margin seen?

                      When you DO get clean margins, are you "cured" pending recurrence?

                      thanks

                      • September 5, 2014 at 9:08 pm
                      Janner
                      Participant

                        You can't assume anything.  Unfortunately, melanoma can come back years after lying dormant.  Yes, the majority of folks in your situation never deal with it again.  But some do.  So it is best to be vigilant, watch for regrowth, watch other moles for change (new primaries).  Learn to palpate your lymph node basins.  I am also stage 1b and was originally diagnosed in 1992.  Long time survivor with no recurrence.  On a site like this, you will find more "exceptions".  People who had a recurrence are more likely to show up here than people who've gone years without one so the site itself is a skewed population and not representative of the actual melanoma population.  Most likely for you, the WLE will be curative.  But be aware that the WLE isn't a guarantee so be watchful in the future.  Depth is the #1 risk, the thinner the better.  

                        • September 5, 2014 at 9:08 pm
                        Janner
                        Participant

                          You can't assume anything.  Unfortunately, melanoma can come back years after lying dormant.  Yes, the majority of folks in your situation never deal with it again.  But some do.  So it is best to be vigilant, watch for regrowth, watch other moles for change (new primaries).  Learn to palpate your lymph node basins.  I am also stage 1b and was originally diagnosed in 1992.  Long time survivor with no recurrence.  On a site like this, you will find more "exceptions".  People who had a recurrence are more likely to show up here than people who've gone years without one so the site itself is a skewed population and not representative of the actual melanoma population.  Most likely for you, the WLE will be curative.  But be aware that the WLE isn't a guarantee so be watchful in the future.  Depth is the #1 risk, the thinner the better.  

                          • September 5, 2014 at 8:51 pm
                          lactansdea
                          Participant

                            thanks….can i assume it is gone forever if a WLE comes back with clean margins? what determines risk after a WLE?

                            • September 5, 2014 at 8:51 pm
                            lactansdea
                            Participant

                              thanks….can i assume it is gone forever if a WLE comes back with clean margins? what determines risk after a WLE?

                            • September 5, 2014 at 8:42 pm
                            Janner
                            Participant

                              Basically the first part justifies the diagnosis.  Line by line analysis isn't all that helpful.  The key points are a depth of 0.7mm, no ulceration, focal regression and 2 mitosis. This is a stage 1b lesion.  You will need a WLE (wide local excision) and you will need to discuss with your doc the possibility of a sentinel node biopsy.  (Some will say yes, others no).  It is a low risk (not no risk) lesion and hopefully gone forever once the WLE is done.  The depth is 0.7mm.  Ideally there would be no depth.  No ulceration is good.  Focal regression is a mixed bag.  Some see it as positive and some negative.  Basically, the body recognized a problem and started destroying it in one localized area. Good in theory, but the fibrosis could hide a lesion that was a little deeper at one point.  Since this is only focalized regression (minimal), I tend to think little info is lost and it's a reasonably good sign.  Mitosis would ideally be <1.  This shows the number of cells seen dividing in a specific area.  Less is better.

                              • September 5, 2014 at 8:42 pm
                              Janner
                              Participant

                                Basically the first part justifies the diagnosis.  Line by line analysis isn't all that helpful.  The key points are a depth of 0.7mm, no ulceration, focal regression and 2 mitosis. This is a stage 1b lesion.  You will need a WLE (wide local excision) and you will need to discuss with your doc the possibility of a sentinel node biopsy.  (Some will say yes, others no).  It is a low risk (not no risk) lesion and hopefully gone forever once the WLE is done.  The depth is 0.7mm.  Ideally there would be no depth.  No ulceration is good.  Focal regression is a mixed bag.  Some see it as positive and some negative.  Basically, the body recognized a problem and started destroying it in one localized area. Good in theory, but the fibrosis could hide a lesion that was a little deeper at one point.  Since this is only focalized regression (minimal), I tend to think little info is lost and it's a reasonably good sign.  Mitosis would ideally be <1.  This shows the number of cells seen dividing in a specific area.  Less is better.

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