Need help interpreting histology results (punch skin biopsy)
Good day.
About a month ago I've removed a mole (nevus) which accrued on "clean" skin (de novo) about 4-5 months ago. It has always been charcoal black and 1,5 mm in diameter.
So the dermatologist did a punch biopsy on it. Results are the following:
*Multiple sections have been examined from specimen submitted.
There is a small central area of melanocytic proliferation seen within biopsy which is subtended by chronic inflammatory cell infiltrate in the upper dermis with incontinent melanin pigment.
Trans epidermal elimination of melanin pigment is seen with some melanin present in cornified layers of epidermis.
There is an atypical melanocytic proliferation noted with some extension into the overlying spinous layers of epidermis.
Conclusion: Atypical Junctional Melanocytic Prolifiration - further wider excision of this area is requested.*
Now, I went to the surgeon and he said it is a melanoma and did the excision with 2cm margins on each side.
What confuses me is the pathologist said it's not malignant while sergion says it is.
What it really is? Is it possible not to have a concrete answer looking at the above histology report? And if not what could possibly clarify it?
Any help is highly appreciated.
UPDATE
I have contacted the pathologist on the phone asking for clarification, and than he mentioned that he does not think it's malignant, but cannot state that on the report as he is not 100% sure.
In any case second excision is sent for a test as well - hopefully it will put some light on this diagnosis.
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How do I interpret a histology / pathology result?
As mentioned in comments, Health.SE isn't a place for personal medical advice, so I'll steer clear of addressing your result specifically. That being said, some general points about pathology reports and some of the nuances may be illuminating for you or others.
Why isn't the result clear?
Rather than thinking in a binary way about results:
? cancer
? not cancer
pathologists can't always be certain- sometimes it's clearly malignant, sometimes it isn't.
? malignant
? probably malignant
? maybe malignant
? pre-alignant
? not malignant
Margins, are extremely important when diagnosing whether a lesion ("lump") is malignant, are by definition not available in a punch biopsy. There are quite a number of factors to balance when deciding whether a sample is malignant or not (eg cell size, shape, differentiation, numbers)
Why are my pathologist and surgeon saying different things?
I don't want to speak for either person involved here; but although both the pathologist want to do the best they can, they may have slightly different 'views'.
The pathologist has been a small specimen of a larger lesion and has to make a determination about what is going on in it. It's not always possible to say with 100% certainty what is actually happening.
Your surgeon has (I assume) seen you, seen the lesion in person, and hear you say that it's a new and recent occurrence. They may have added that knowledge to the pathology report and decided that on the balance of probability that it is malignant, and that it should be removed.
Disclaimer: the above is speculation, and merely offered as a possiblity as to why they are saying different things. If this concerns you, then read the next section.
What should I do?
As recommended, speak to the doctors involved- the pathologist and the surgeon. They should be happy to explain their reasoning to you and be able to clarify what they mean and why they made the decision they did.
If that does not satisfy you, you always have the option to seek a second (in this case, third!) opinion.
Further reading
Pathology services explained - starts with "Unlike the pathologists you might see on the television...", which is a good start in my book
Punch biopsy outline from American Family Physician
Reading a Pathology Report from cancer.net
Further Disclaimer / TL;DR
There may well be some pathologists reading this who are thinking "that's way too oversimplified" or similar. Really, it's probably still too complicated. It's a tricky job to do and so it's not easy to summarise a speciality in an answer on a Q&A site.
The take-home message is in the bullet points above: pathology does not always give a clear answer.
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