Newly diagnosed, pathology report help needed please.

Posted By
Mommyto2
6/19/2017 2:26pm
View other posts by
Activity
Replies: 12

Hello all, I read a lot on this site after my biopsy, and I received the bad news of cancer on 6/16/17. I ignored a new mole for about 5 years. Very dumb, I know. When the mole started changing in appearance, I got it biopsied. Now I'm losing my mind, I can't stop thinking about my children and the effect this will have on our family. I will post what my path report said in hopes that some of you kind souls will interpret for me. All I know is that, yes it is melanoma, and I have an appointment scheduled for 6/30 for a wide local excision and snlb. Path report :
SKIN, UPPER BACK, LEFT SHAVE BIOPSY
- INVASIVE MALIGNANT MELANOMA
SUMMARY:
HISTOLIGIC TYPE: NODULAR MELANOMA
MAXIMUM TUMOR THICKNESS: 0.96 MM
ANATOMIC LEVEL: IV
ULCERATION: NOT IDENTIFIED
MITOTIC RATE: 5 MITOTIC FIGURES PER SQUARE MM
STAGE: pT1b
This was a shave biopsy, please help interpret this for me. I'm losing it and everything I try to research is just making me more confused. Thanks in advance.

Hi Mommyto2,

Does the path report state if the borders were clear? 

Thank you for replying, the only thing on the path report that even has the word borders in it, is the clinical history or description of my mole before it was shaved. Its described as having irregular borders.

What I should have asked was if the margins were clear, this would help determine if the tumor was totally removed or if there is residual tumor that needs to be taken out during your wide excision. I know the diagnosis is scary, I was recently diagnosed in January. I had a wide excision and slnb in March. I am a stage 2a , my melanoma was 1.50 mm, ulcerated and had a mitotic rate of 3. I am seeing a melanoma oncologist and dermatologist every 6 months and not a day goes by that I don't worry about this disease. 

Hi - sorry to hear you got this news. I'll do my best to explain some of these terms. Firstly, now that you have had a melanoma, can I suggest that any future excisions be proper excisional biopsies not quick-and-easy-but-liable-to-bisect-melanoma shave biopsies?  Just a little bee in my bonnet that I have, the gold standard is excisional biopsies for suspected melanoma, not shaves because its too easy to bisect the base of the melanoma and in doing so destroy any chance of establishing true depth. Secondly, location: better to have melanoma on limbs than torso, but better torso than head/neck, so there's that. This is a fairly weak indicator of anything but I have read this somewhere. Thirdly, invasive. Not good, better to have in situ which means melanoma is confined to epidermis and nowhere near lymph and/or blood pathways that enable metastases. Invasive means that its spreading vertically and that might bring it into contact with blood/lymph and carry it to other parts of your body.  Nodular: also not good, considered to be more aggressive type than other types such as lentigo maligna melanoma or superficial spreading melanoma. Tumor thickness: 0.96mm - actually pretty thin, but close enough to the recommended 1mm cutoff to get a SLNB, so good that you are getting one. Also, the nodular aspect would warrant the SLNB given their reputation for being a little bit more aggressive. Anatomic level: IV. This is actually an older way of measuring melanoma depth, now it's only relevent to thin melanomas like yours. It does mean though that on a scale of I-IV, the melanoma has progressed deeper into the dermis. This only goes up to V (I being shallowest, V being deepest). Ulceration: not identified - this is great news. Ulceration is a poor prognostic sign. Mitotic rate: 5 - this is on the higher side, anything equal to or more than one is considered to be a poor prognostic sign.The main thing is, as someone below is trying to establish, is: is 0.96mm the actual complete depth, or did the shave biopsy cut off the base in which case you'll never know the true depth? If it is the actual complete depth it's actually pretty good news, despite all my humbugging. It would put your melanoma at the 'high risk' end of a 'low risk' lesion category. In other words, you have a low risk melanoma but slightly higher of a risk than say a thinner or non-nodular type with a lower mitotic rate. Depth is by far the most important variable, and yours is still pretty thin.

Thank you so much for explaining. I only learned of the importance of the excisional biopsy after my shave was done. This is a lot to digest, I'm still wondering how they can tell it is Nodular Melanoma, I guess they can tell from the shave? She did shave kind of deep. I think I'm still in shock. God bless you all, the journey ahead will be hard, and I will fight.

You're very welcome. Don't lose hope, keep in mind that yours is a low risk lesion but in that category of low risk, it would be in a kind of subcategory of higher risk because of a) nodular type b) mitotic rate c) depth getting close to 1mm, which is the depth where doctors start testing nearby lymph nodes for spread. You are defintely on the right track with treatment, let's hope that the WLE and SLNB are both clear and you join the next stage of a melanoma diagnosis: the watchful worriers who just have to keep a close eye on regular skin checks and any signs of metastases. All going well, the initial stress (which to me is by far the worst 'symptom' of melanoma' dies down after about six months. It can be very stressful early on, often for no good reason as your prognosis is good, so look after yourself.

ETA I shouldn't assume you are a worrier... I just know that I was, so assume everyone is!

Worrying non stop! It makes you think about everything!! Kids, spouse, family, living!! I will be on the site and will check in with any updates. I'm red headed, freckled with green eyes, should have known better..but awareness of Melanoma was certainly lacking sadly.

If there's one good thing about melanoma it's that it gives you a new appreciation for the beauty of life and the ones we love... No more sweating the small stuff, so to speak. There's no real need to swamp yourself in scary info, you have a good prognosis and are getting great care. Make a conscious effort to enjoy life at this time, don't let melanoma exact too high of a mental price on you. Easier said than done, I know.

That is great advice, it definitely has robbed me of all happy moments since I've been diagnosed. I just found out that my appointment on the 30th is not for surgery, it is for a consultation to see if I NEED surgery. The derm told me otherwise. Time is of the essence and this really annoys me :(

There is always a consultation appointment before a surgery appointment, it's just how surgery offices run. No worries about time, many of us waited weeks between diagnosis and surgery. Hang in there.

Your life will settle down. I was diagnosed with 2 cancers in 1 year. 1 cancer stage 1 and I transferred all my app for medical to cancer center. And Melanoma insitu was diagnosed. 10 months apart and living with no family in the US - originally from Europe. My kids are now 13 and 15. Life is different but it's a new wonderful life. Praying a lot, thankful for a lot. I am heading on a cruise with my family. I will follow sun safety but will enjoy Beach as well. You will find new normal and enjoy  life again. I was diagnosed almost 2 years ago with my 1st cancer and Melanoma in situ in October 2016. I had wle 1 week before beach vacation that I planned to recover from my 1st cancer...