Update for Staging Diagnosis from a Pathology Report from a Biopsy

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5/28/2013 3:11pm
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I'm now more nervous than before. I took your advice and I just picked up a copy of my pathology report here is what it says:

SURGICAL PATHOLOGY REPORT

MICROSCOPIC DIAGNOSIS:

Skin, left medial foot (excisional biopsy):
ULCERATED NODULAR AND INFILTRATING MELANOMA (BRESLOW DEPTH >5 MM), EXTENDING TO THE DEEP MARGIN. Immunostains (Melan A, cytokeratin 5/6, cytokeratin 7) are confirmatory. Positive and negative controls stain appropriately. Focal lymphatic invasion is noted. Dr. Sahmel has seen the slide and concurs.
Only a small amount of possible in situ melanoma is seen. While this can be explained by ulceration, clinical correlation is recommended to exclude metastatic melanoma.

SYNOPTIC

Procedure: EXCISION
Specimen Laterality: LEFT
Tumor Site: MEDIAL FOOT
Tumor Size: 1.5 CM IN WIDTH
Macroscopic Satellite Nodule(s): NOT SEEN
Histologic Type: UNCERTAIN BECAUSE OF MINIMAL NATURE OF IN SITU COMPONENT.
Maximum Tumor Thickness: > 5 MM
Clark Level: AT LEAST LEVEL 4
Ulceration: PRESENT
Margins: DEEP MARGIN POSITIVE FOR INFILTRATING MELANOMA. Because of the polypoid nature of the lesion, there is essentially no lateral margin to the specimen that is distinct from the deep margin.
Mitotic Rate: HIGHLY VARIABLE; UP TO 5 PER SQUARE MM IN SOME AREAS.
Microsatellitosis: NOT SEEN
Lymphovascular Invasion: PRESENT
Metastases: UNKNOWN
Pathologic Staging (pTNM): T4b NX MX

DBD/dbd

Gross Description: blah blah blah

This is concerning to me. Can someone give input as to what this means?

Thank you.

Alana, this is essentiallly what you described in your previous post. The lesion is melanoma (nodular melanoma). The next steps-- getting to a melanoma specialty center and getting PET, CT, and/or MRI scans and blood work-- remain the same. The importance of getting the tumor tissue tested for BRAF and c-Kit mutations remains the same.

I know how agonizing it is to wait for your appointment at Johns Hopkins. The periods of twiddling your thumbs and waiting are probably the hardest thing we have to bear during this whole stressful journey.  We want to DO something! NOW!! But really, I don't think that there is anything anybody can tell you at this point unless and until you find out your melanoma stage and what your doctors are recommending. 

I"m sorry, honey, Please try to do whatever you can to defuse your anxiety-- exercise, meditate, dance, take Xanax, whatever. There is nothing you can do and you have no decisions to make until after you get your results from JH.