Dear OncoLink "Ask The Experts,"
I recently had a punch biopsy done on my left forearm. Could you please help me understand the pathology report? DIAGNOSIS: Atypical intraepidermal melanocytic proliferation, trailing to the lateral side margin. COMMENT: Sections demonstrate an intraepidermal proliferation of predominantly single and focally nested melanocytes distributed in a lentiginous pattern. This change is seen within a background of hyperpigmentation. While not diagnostic for melanoma in situ, the histologic are unusual and atypical. As such, complete, but conservative, re excision is recommended.
Suzanne M. McGettigan, MSN, CRNP, AOCN, Board Certified Adult Nurse Practitioner and a Certified Oncology Advanced Practice Nurse, responds:
The area that you had removed is described as being “slightly atypical”. If you think of melanoma as being on one end of a spectrum and a normal mole as being on the other end of that same spectrum, this mole that you had removed would be placed somewhere in between. It has some unusual or atypical features within the melanocytes, which are the cells from which melanoma develops. When your pathology report describes the affected cells as “trailing towards the lateral margin”, this means that on every other edge of the tissue that was removed from your arm, there is a band of normal tissue; however, on one margin there is not that same band. It is for this reason that a “conservative re-excision” was recommended. The purpose of this re-excision would be to ensure that no abnormal cells remain.
Given the development of this atypical mole on your forearm, you should plan to see a dermatologist on a regular basis for skin examinations. You can also perform a self skin examination to look for any changing moles. When we think of what to look for with melanoma, we often think of the ABCDEs of early detection. Moles that are suspicious for melanoma are often asymmetric, have irregular borders, more than one color within a single mole, a diameter greater than 6 mm or the size of a pencil eraser, and evolution or change over time. If you notice any of these changes within one of your moles, you should bring it to your dermatologist's attention right away. Although you can't change the damage done to your skin during your younger years, you can protect yourself from UV damage moving forward, protecting your self from melanoma and other non-melanoma skin cancers. Sun protective behaviors include avoiding peak sun exposure times, avoiding artificial sources of UV light, wearing protective clothing and sun glasses, and wearing sunscreen with an SPF of at least 15 on all sun exposed areas.
Jan 10, 2013 - Despite considerable controversy surrounding the third interim results of the Multicenter Selective Lymphadenectomy Trial, which indicate a benefit of sentinel lymph node biopsy on disease-free survival in melanoma, the procedure is carried out routinely, according to a report published online Jan. 8 in BMJ.
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