Question Re: Path Report

Posted By
11/23/2017 10:12am
Replies: 2

Had a shave biopsy last week.  Nurse called yesterday and said I had to have an excisional biopsy done soon but not to worry because it's not melanoma.  I'm scheduled for the next biopsy on December 4th.  I'm just not sure why I have to have another biopsy if it's not melanoma.  This is what my path report says:

Skin of lateral back, T4, right, shave biopsy:
Melanocytic nevus, compound type with unusual architectural features and
severe cytologic atypia. See microscopic description and comment.
Margins negative for nevus in the plane of the sections examined.

Histologic sections are that of a shave biopsy of skin to the deep
reticular dermis. Centrally, is a compound melanocytic proliferation. The
majority of the lesion is an epidermal melanocytic proliferation consisting
of enlarged vacuolated melanocytes with variable cytologic atypia forming
irregularly sized and shaped nests and single cells which are unevenly
spaced along the dermal epidermal junction. In the superficial dermis are
smaller melanocytes forming nests with a tendency for smaller nests and
single celled growth with descent. A rare mitotic figure is present in the
superficial dermis. There is an associated mild to moderately dense
superficial lymphomononuclear infiltrate and associated dermal melanocytes.
Immunohistochemical stain for MART 1 performed and interpreted here
highlights the aforementioned features and rare scattered melanocytes
demonstrating upward migration but no well-developed upward migration or
confluent growth is identified. Deeper sections have been reviewed.

Any help interpreting this would be greatly appreciated.

Janner - (11/23/2017 - 3:10pm)

Severely atypical lesions are recommended to be removed with 5mm clear margins.  They are NOT melanoma but they do shows signs of possibly heading that direction.  They are not your normal run of the mill mole.  So to be on the safe side, they recommend removing these lesions with the same margins they use for melanoma in situ.  This is erring on the side of caution.  You don't have to have the excision if you don't want but you'd be going against the standard of care prescribed for this type of lesion.  Either way, watch the scar area for any pigment regrowth and report to the derm.

Tressa48 - (11/23/2017 - 4:58pm)

Thank you, Janner.  I will have the excision, because I trust this doctor.  But i was curious as to  why she recommended this and I grew up in an age where you don't question your doctors, you just do what they say.