melanoma in situ pathology report

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3/12/2013 11:15pm
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Replies: 6

Hi.
I have a question about my path report.
from what i,ve read mine does not include mention of most of the item talked about or read about
Online. It is from Columbia dermatpathology NYC.
It reads: " I interpret this as in situ melanoma, possibly arising in a dysplastic nevis.
The lesion extends to one peripheral margin in the plane of bisection."
This was ashave biopsy.
Micro: the specimen is bisected and shows confluent junctional melanocytic nests as well as many
Single melanocytes extending upward within the epidermis.

Is this sufficient? I,m puzzled that thi eas all that was written.
Appreciate your opinions. Thanks.

What are you expecting it to say?  I'm unclear on that.  In situ melanoma has it's own implied definitions and maybe that's what you are missing.  In Situ means Clark's Level 1 and Breslow 0.  The melanoma is totally confined to the epidermis and therefore has no depth.  Breslow depth is determined from the epidermal/dermal junction downward into the layers of skin.

Melanoma in situ has an extremely high survival rate and surgery obtaining at least 5mm margins will be your next step.  After that, watch the scar area for any pigment regrowth, watch your other moles for change, and practice sun safety.

Best wishes,

Janner

Thankyou for responding.
I think I WAS concerned because i had had that spot on my foot for years and the report said " possibly" arising from a dysplastic nevis.
That mole i told my dr., a few years back had gotten red or inflamed at one point and seemed to peel off and disappear, but then was there after the process or spot healed and looked tthe same as always.
So i had concerns about the regression phenomena.
How this was discvered was in dec. I thought it might appear to be very subtly getting a bit bigger. It was 5 to 6 mm.
So was this amole to begin with that changed recently or always an insitu or worse--- a regressed lesion.
My doctor said if there was any evidence of regression they would have stated it in th path report.
Sorry for tyypos--- ona tablet. Thanks

I've looked at a lot of pathology reports over the years.  If it isn't stated directly, it wasn't seen.  Some reports are more verbose than others.  Some even include a "checklist" of features.  Most don't.  If regression was seen, it would have been noted.  And if there was major regression, the lesion most likely would have been fading or getting smaller or missing parts of it.  I've had several normal looking moles just fade.  That is regression and it's a normal process and happens in normal moles.

About 50% of melanomas arise from an existing mole. I have also had moles that got irritated but went back to "normal" later.  Whether this arose from a mole or not really doesn't change much in the scheme of things.  Most lesions "evolve" and if this was on a spot you've had for a long time, I think it's pretty easy to assume it was started in an existing nevus and had started to change from there.

If this still has you worried, you can always have the slides sent out for a second opinion on the pathology.

Best wishes,

Janner

Thanks much!
Helps me to understand better. My doctor said same that I could have slides looked at elsewhere. My doctor seemed annoyed that I was even questioning...

In the whole scheme of things, an in situ melanoma isn't that serious compared to other melanoma lesions a doctor encounters.  I think it is easy for them to brush off your concerns because they really know the long term prognosis for you is extremely good.  However, that doesn't help you when newly diagnosed and your shock and fear factors are high.  You have valid questions and concerns and if your doctor isn't willing to give you time, answers and consideration, I might consider another doctor.  You want one who works WITH you, not one who isn't considerate of your concerns.

Best wishes,

Janner

You bet!
Thankyou so much.
That is how I felt frightened. But I know its nothing in comparison to what others deal with......
I wish everyone well. Strength, peace, and successful treatment,with compassion and kindness.
Nancy