Clarification Needed on Skin Biopsy Results
Three weeks back, my dermatologist excised a mole she deemed worrisome and sent it for biopsy analysis. I received the results just this evening at 5 PM, moments after the office had closed, and it seems I won’t be able to get an explanation until Thursday. I’m reaching out in hopes that someone can shed some light on these findings for me. From my preliminary online research, I gather that it may be a benign mole; however, I am puzzled by the recommendation for re-excision and the mention of an imperfect PRAME result. **FINAL DIAGNOSIS:** 1. **Skin, Left Mid Upper Back, Shave Procedure:** A. A combined intradermal melanocytic nevus, demonstrating characteristics of both a banal nevus and a common blue nevus (refer to comments for more information). B. The lateral margin shows involvement. **COMMENTARY:** 1. The analysis of the biopsy slides reveals sections of an intradermal melanocytic growth, which consists of a layer of superficial small epithelioid melanocytes with vesicular nuclei situated in the papillary dermis, along with deeper hyperpigmented spindle-shaped melanocytes. The presence of melanocytes is confirmed via SOX-10 staining. However, the PRAME result is technically flawed. BRAF gene testing returned negative, while P16 expression is maintained. Due to the positive margins, it is recommended that a complete re-excision be performed to ensure thorough removal and to avert any risk of recurrence or further progression of the lesion. The reviewing physician concurs with this interpretation. **MICROSCOPIC DETAILS:** The findings at the microscopic level support the provided diagnosis. **GROSS DESCRIPTION:** The first part of the sample is tagged as originating from the left mid upper back (showing pigmentation at the base of the shave, followed by additional shaving and a punch biopsy to eliminate all visible pigment). The specimen comprises three pale tan to tan pieces measuring between 0.2 x 0.2 x 0.1 cm and 0.5 x 0.4 x 0.1 cm, all of which have been fully submitted in a cassette labeled "1A." I'm hoping to better understand what these results imply and the next steps I should consider.
Answers (1)
4/23/2025, 12:01:15 AM
OpenHealth AI
Thank you for sharing your biopsy results and concerns. It’s understandable to feel anxious about the findings, especially when you have to wait for a full explanation from your dermatologist. Here’s a breakdown to help clarify your results and the implications, as well as the steps you should consider next.
Main Points:
- The biopsy showed a melanocytic nevus, a type of mole that can be benign.
- The report indicates positive margins, meaning not all of the abnormal cells were removed.
- A complete re-excision is recommended to ensure all affected tissue is removed and to reduce the risk of recurrence.
Explanation:
Your biopsy report suggests that the mole contains features of both a banal (benign) nevus and a blue nevus. Typically, such moles are not harmful, but the important aspect here is the mention of positive margins. This means that some of the cells of concern were still present at the edges of the excised sample.
The recommendation for complete re-excision is to ensure that any remaining cells are fully removed, which helps prevent any potential progression or recurrence of the mole. The commentary you mentioned about the PRAME result indicates that there might have been an issue with the test used to assess the mole further. However, this does not change the recommended next steps.
Next Steps:
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Prepare for your appointment on Thursday: Write down any specific questions you have regarding the biopsy results and the re-excision. Understanding the risks and benefits of the re-excision will be helpful.
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Follow the recommendation for re-excision: Plan to schedule this procedure as soon as you feel comfortable and understand the details from your dermatologist.
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Practice good care for the biopsy site: If your dermatologist provided any care instructions for the site of the initial biopsy, follow these to avoid infections or complications. Keep the area clean and dry, and limit sun exposure.
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Monitor for any changes: Keep an eye on your skin for new or changing moles, redness, swelling, or any symptoms that concern you.
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Stay informed but avoid anxiety: It’s good to seek information, but be cautious with online research as it can sometimes lead to unnecessary worry. Wait for your doctor’s professional interpretation.
It's great that you are being proactive about your health. If you have further questions or need clarification after your appointment on Thursday, don’t hesitate to reach out. Remember, you’re taking the right steps in monitoring and addressing your health.
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