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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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    Can you get in touch with the original pathologist and ask them to clear up the confusion?
    – bertieb
    Mar 30, 2017 at 10:52
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    Welcome to health SE :-). We can't offer personal medical advice here, your questions are best answered by a doctor in person, they know much more about your condition than we could over the internet. What I can't see from your question is where do you see that the pathologist said explicitly that there is no malignancy? It was the pathologist who referred you to the surgeon in the first place, wasn't it? To resolve any conflicting information from 2 MDs you can either go back to them and ask for clarification, or see a third one.
    – Lucky
    Mar 30, 2017 at 11:05
  • Thank you for updating your question- I actually wrote an answer (for the general case) along those lines, which hopefully sheds some more light on the situation for others as well as you. Regardless of anything else, I hope things go well for you and you have a good result :)
    – bertieb
    Mar 30, 2017 at 20:27
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    Before my own diagnosis I thought a biopsy was to see if something needed to be removed, with the default being to leave it. I've learned that a biopsy is mostly to see if something can be left, with the default being remove it. If your pathologist isn't sure, it's coming out.
    – Kate Gregory
    Mar 31, 2017 at 0:22
  • I don't see anything in the pathologist report that says it ISN'T malignant. I do see some concerning features like atypical proliferation, and that they want more sample. Depending on size and location, some dermatologists and onc surgeons will do a biopsy by excising the whole thing with an estimated margin - then go back to excise wider depending on pathology report. But others punch to ensure depth is measured. Also, melanoma is practically malignant by definition. They spread readily and rapidly so people don't mess around with them.
    – DoctorWhom
    Apr 1, 2017 at 2:24

1 Answer 1

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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

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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    Excellent answer navigating the role of pathology in diagnosis. Final diagnosis and treatment plan rarely are made independently from the physical exam and clinical history, about which the pathologist usually does not have a full discussion with the physician who ordered the biopsy. Sometimes they will discuss after the pathologist reviews it - I've done that myself with pathologists radiologists specialists etc - to correlate findings. And yes, it is always appropriate to ask a physician to explain further so that you understand your health and medical treatments!
    – DoctorWhom
    Apr 1, 2017 at 2:14

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