I'm not too happy to be here, frankly, but very glad to know I'm not alone. I was diagnosed with a melanoma on my arm, near my elbow. The pathology report is this:
Note: Preliminary Depth: at least 1.6mm to base
Preliminary Level: at least Clark's Level IV, to base
Regression: Not identified
Lymphovascular invasion: Not identified
Tumor infiltrating lymphocytes: Not identified
Margins: The deep margin is focally involved; the side/peripheral margins appear negative.
Clinical Impression: DF
Gross Description: 8x7x1 bisected
Original and multiple deeper levels were prepared and reviewed at dermatopathology consensus conference. Sections shows a shave biopsy of skin with focally ulcerated epidermis in the center of the biopsy, covered by a scale crust. In the dermis there is a proliferation of large slightly pleomorphic cells with vesicular nuclei and abundant pale cytoplasm. In some areas these cells are arranged in nests whereas in other foci they form long fascicles. Focally, there are similar cells at the dermoepidermal junction. The cells do not mature with their descent into the dermis. Numerous mitotic figures are seen throughout the lesion including the deep portion of the lesion. A panel of immunohistochemical stains is performed. The cells are positive for S100, NGFR, and Vimentin. They are negative for Melan A, HMB-45, cytokeratin 116, CD10, and Desmin. MIB-1 labels numerous nuclei within the lesion.
So I go see a surgical oncologist in a few days but some questions. From what I've been reading around the web, some things on this report look bad (like the high mitotic rate) and the fact that they are calling this a "shave biopsy" which, along with the mitotic figures in "the deep portion of the lesion" looks like I still have more to take out.
I'm thinking the best this could be would be Stage II at this point but obviously they'll have to try to get the rest of the cancer. My question is does this pathology report indicate a sentinel node biopsy should be done? And from what I'm reading, results are likely to be positive because of the high mitotic rate... so does that mean they automatically take out the whole cluster of lymph nodes?
I know I should (and will) be asking the specialist about all this but just wanted to be prepared.
Thanks for any and all help and advice!! I'm a bit worried but I am also a realist and a fighter... I like to know what I'm up against. :)