Path Report

Posted By
Boo79
6/11/2018 6:39pm
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Replies: 3

I received this pathology report today  I've had several reports from several miles being removed. I've never had any say this, so could someone explain this to me? Thanks.

CLINICAL INFORMATION: R/O melanoma.

OPERATION: 1) R breast. 2) back.

(Clinical Information and Operation obtained from the Requisition submitted
with specimen)

DIAGNOSIS:
A. Skin, right breast:
- Case was sent out for a consultation, will be reported as an addendum.

B. Skin, back:
- Case was sent out for a consultation, will be reported as an addendum.

GROSS PATHOLOGY: A. R breast – received in formalin and consists of a
skin shave, 0.5 cm in greatest dimension. Bisected and submitted entirely
in A1.
B. Back – received in formalin and consists of a skin shave, 0.6 cm in
greatest dimension. Bisected and submitted entirely in B1. RS:rh

MICROSCOPIC PATHOLOGY: A. Sections of the right breast skin biopsy show
irritated benign seborrheic keratosis.
Part B, the back skin lesion shows compound nevus with tissue
acquisition artifact present at the biopsy margin. Melan-A and SOX-10
stains show focal melanocytes within the epidermis. Control sections react
appropriately. KK: mb

88305 x2, 88342 x1, 88341 x1

 

 

ADDENDUM: This case was referred to ARUP for consultation and their
diagnosis reads as follows:
A. Skin, right breast, shave biopsy: Favor compound melanocytic nevus (see
comment).
B. Compound melanocytic nevus.

COMMENTS:
A. Focal melanocytic nests are seen along the dermal-epidermal junction and
within the dermis and extend to biopsy edges. I assume this specimen is
representative of the entire clinical lesion. If a clinical lesion
persists/recurs, a complete sampling would be advised for definitive
diagnostic purposes.

 

 

Janner - (6/12/2018 - 11:21am)

The final diagnosis for both are compound melanocytic nevus.  No atypia noted in cells or architecture.   Looks like two basic moles and nothing more.  However, the biopsies were done with shave and not all the lesion was removed, so it is possible they could grow back. 

Just a comment:  If you are truly biopsying with the thought that something could be melanoma, shallow shaves like this could compromise staging information in the future.  If you bisect a melanoma lesion, you will never know the exact depth and depth is the more important prognostic indicator with melanoma.

Anonymous - (6/12/2018 - 4:13pm)

Actually a deep shave biopsy is now thought to be fine for a suspicious mole.  See this older but current thinking: https://www.facs.org/media/press-releases/jacs/shavebiopsy0511

Janner - (6/12/2018 - 4:40pm)

Any biopsy type will work and a shave has its advantages over a punch when it is a wide lesion.  But so many docs don't do a DEEP shave.  If you knew how many times I have seen a bisected lesion discussed on this site over the past 17

years, you would understand my reluctance to endorse any shave.  I, personally, will not have a shave.  But for me, it goes beyond losing info - they just hurt more and heal worse for me than punches do.  Any biopsy is better than no biopsy.  And yes, many time the lesion is totally removed with a shave.  But there are still too many times when that doesn't happen and people are left with incomplete staging on their primary.   If you ask your doc for a deep shave, then great - you're more likely to get it.  But even specialists who don't think this lesion is "anything" make mistakes.  I'll take a full skin thickness biopsy any day over a shave - just my opinion only.