Hello the community, I need your help to understand my report

Posted By
Anonymous
11/23/2017 8:13pm
Activity
Replies: 4

- Dear everyone,

 

First, thank you for your help and consideration regarding this post.

 

September 2016, I noticed that one of my mole turned pink / red instead of light brown I think.

My dermatologist did a shave and sent it to the laboratory for a biopsy.

 

REPORT 1 : Shave Biopsy at Dermatology Institute

0.4 cm in greatest dimension

Microscopic Description:

Sections show skin with a domed surface. The overlying epidermis is hyperplastic and shows hypergranulosis and compact hyperkeratosis. Situated at the D-E junction are nests of large spindled and epithelioid melanocytes, some of which are separated from the epidermis by clefts. Kamino (dull pink) bodies are present. The dermal component shows focal maturation and a single deep dermal mitotic figure is seen within intradermal melanocytes.

Diagnosis :

 

Skin, right lower abdomen shave biopsy:

- Atypical Spitz tumor, suspicious for malignant melanoma, involving the peripheral margins, deep margins negative.

Comment : 

The fiding are worrisome for a malignant melanoma. Features in favor of this include poor circumscription, asymmetry, and the presence of rare deep dermal melanocytic mitotic figures. Additional FISH genomic would be helpful. A complete excision is recommended.

--> Okay, I was totally lost at that time, my dermatologist told me that it was very small, but we have to cut it out. 

Report 2: Complete excision, biopsy at UCLA Health 

FINAL DIAGNOSiS : 

SKIN, RIGHT HYPOGASTRIC AREA (EXCISION):

- Residual atypical melanocytic proliferation, excision margins are clear

- Dermal scar and prior biopsy site changes

ADDENDUM 1 :

Recut sections for send-out (requested by the patient) were performed and reviewed. A similar somewhat "epithelioid' proliferation is identified within the region of prior biopsy changes. This may represent atypical epithelioid melanocytes (as originally described) or "epithelioid" histiocytes secondary to the prior biopsy. No malignancy is identified the sections examined. Excisions margins are clear.

Finally, I asked for a second opinion in France, I sent all my slides there.

The final diagnosis is:

Atypical Spitz Tumor (MELTUMP) 

No evidence of malignancy  --> no Spitzoid Melanoma, especially because proliferation and mitotic rate is not high, but the Spitz has some atypia ( cannot translate it into English, it is so hard :)

Well, I am really lost, I really do not understand what I had. Now both of my dermatologist from Los Angeles and France told me that this is over. Just that I have to be Sun Smart to make sure that I will not get a second suspicious mole.

Thanks for your time,

Regards

 

 

 

By the way, I am 25 ! 

 

Thank you ! 

You had a Spitz nevi or atypical Spitz.  Basically, Spitz lesions are totally benign and most often found in young individuals.  However, they look almost identical to melanoma under the microscope.  The FSH test does a DNA analysis of the lesion to see if there are a lot of DNA defects identified (melanoma) or looks mostly normal (Spitz).  Both reports determined that you had a Spitz nevus and that it was benign.  It's been removed with margins so you're good to go and not worry about this one anymore.

Thank you Janner !

 

But it says on the first report ( shaving ) that this is a atypical Spitz Timor Suspicious for malignant melanoma.

that is why it’s confusing for me.

 

also, what does deep margin negative mean ? 

 

Thank you

As I said, the two diagnoses are similar. But the final diagnosis listed was Spitz, not melanoma.  That's the important info.  Negative deep margins means the shave removed the entire depth and didn't bisect the lesion.