Can someone interpret my pathology report please?

Posted By
Amy Green
9/13/2018 6:19pm
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Replies: 5

I'm a 29 year old female. Had a mole biopsied which came back positive for melanoma. I'm waiting on a call from the oncologist to know what comes next but hoping someone can look at this and tell me. Results below, thank you in advance!!

Malignant melanoma, superficial spreading type

Comment: Tumor Stage (pT) - T1bNxMx
Clark Level: IV
Below thickness: 1.0 mm
Radial (non-tumorigenic) growth phase - Present
Vertical (tumorigenic) growth phase - Not identified
Mitotic figures: 1/MM2
Ulceration: Not identified
Regression: Not identified
Vascular/lymphatic invasion: Not identified
Perineural invasion: Not identified
Microscopic satellitosis: Not identified
Tumor-infiltrating lymphocytes: Non-brisk
Associated melanocytic nevus: Not identified
Predominant cytology: Nevoid
Surgical margins: The margins are free of invasive of melanoma. The melanoma in-situ component extends to one lateral margin

ICD: D48.5
R/O: Neoplasm of Uncertain Behavior, Dysplastic Nevus
Morphology: Plaque

Present within the epidermis and dermis is a proliferation of atypical melanocytes. The dermal component displays small cell (nevoid) morphology. The epidermal atypical melanocytes are arranged in nests and single cells at the dermal-epidermal junction, and as solitary units above it. Obvious extension of the epidermal component beyond the dermal component is identified. Double immunohistochemical studies using Ki67/MART-1 reveal moderate proliferation index. Deeper sections have been examined.

It looks like you have melanoma in situ.   If you have melanoma, it is the type to have.   They will probably re-excise to get larger margins, but it appears no vertical invasion, which is great.   After margins are achieved you will likely just be on a diligent follow up schedule for skin checks with your dermatologist. 

Your melanoma is isolated to the area they excised and has not spread anywhere else.

Stage 1b at this point.  Your lesion was 1mm deep.  interestingly, it says it didin't have a vertical growth phase, only a radial.  Very unusual.  Typically you see radial only in stage 0 (in situ) lesions but it is acknowledged that it can happen in deeper lesions - maybe lesions that already existed in the dermis.  I'd say 1mm is the deepest I've ever seen with no mention of vertical growth and I'd still question that.  Most of the other characteristics are what you'd like to see.  Clark Level IV is an older classification but corresponds to the breslow depth/thickness.

Next steps:  Sentinel Lymph Node biopsy (SLNB) and Wide Local Excision (WLE).  Staging may be updated depending on those results.

Thank you very much! That is about what I was assuming based on the small amount of reading I've done based on my results. Would you recommend questioning my dermotologist about the vertical growth assessment or just wait and speak to the oncologist?

I'd ask both but the derm may have a better knowledge of the pathologist who reads his slides and he could talk to the pathologist if clarification is needed.

Okay great. Thank you for the input, I appreciate it!