Question:
17 yr old girl, fair skin, no family history of melanoma only about 15
other small moles, only been sunburned twice (mildly). 1 cm diameter
solitary mole on leg near knee, brownish, smoothly rounded, symmetric.
Original mole formed 8 yrs ago, began changing color and became
darker in last 6 months. Shave biopsy. Pathalogy report says
"...severely atypical melanocytes...", and I cannot remember more.
With this little info, what would you say?
Answer:
Obtain a copy of the original pathology report. Also obtain copies of
any subsequent pathology reports from examination of the original
specimen (hopefully by a dermatopathologist).
Your mention of "severely atypical melanocytes" does not imply melanoma.
If melanoma is truly present the pathology report will likely include
statements about Breslow's Thickness and Clark's Level. These terms
are used to describe the thickness of the melanoma and how deeply the
melanoma has invaded the skin layers.
You state the sample was 2 mm thick but do not mention how thick the
cells of interest were. Is that listed in the report? Or was it not
because it is not melanoma?
A sentinel node biopsy is suggested for thicker melanomas that have a
greater possibility of invading and spreading. SNB is not necessary for
very thin melanomas that have not invaded the deeper layers of the skin.
What is your reasoning for a deeper excision? Were all of the cells of
interest not removed by the shave biopsy? This should be described in
the pathology report. If the original biopsy was deep enough to remove
all the cells of interest then a deeper excision may be unneccessary.
You should discuss the pathology report with your physician and
dermatologist.
