I wanted some of your opinions on the interpretation of my mother's biopsy results. I am pretty familiar with interpreting these since I myself have had multiple atypical moles but I'm having some disagreement with the PA that I spoke to about this. We went in to get a "mole" biopsied that clinically looked like an atypical mole/melanoma. I saw it change over the span of two months which is why we went to get it checked. This is the result.
left lateral hand (shave)
Extremely superficial biopsy showing an apparent pigmented hypertrophic actinic keratosis, transected at the base.
Comment: The superficial nature of the biopsy limits assessment.
Right index finger (shave)
Pigmented actinic keratosis
Now, to me that doesn't sound like a definitive 100% diagnosis especially when the pathologist is basing his diagnosis on a limited assessment. The fact that the assessment was limited worries me as clinically it looked like a atypical mole and the differential diagnosis for pigmented actinic keratoses is melanoma in situ. Now I requested for a second opinion, just for another pair of eyes to look at the slide to see if they could get a better assessment. The PA I spoke to said that's not necessary because I'm not interpreting it correctly as the pathologist actually meant that the superficial portion of the biopsy is precancerous not that the biopsy tissue itself is superficial. Now, I don't see what she sees. If what she said is correct then the pathologist would have written the same thing for the results of my mother's index finger.After much pushing on my side she said she would call the lab but I don't know if she's calling for them to interpret the results for me or to ask to re-read it. Either way it was a very long frustrating phone call and I would appreciate what you all think of this result. Thank you.
I can understand your concern, but I think you may need to re-think the meaning of "superficial" here. In pathological terms, superficial simply means "on the very surface of the skin." This would mean, in your mother's case, on her left hand, the actinic keratosis is on the very top layer of skin. It hasn't grown down to any lower layers. This would make indepth analysis limiting - which makes sense and is actually very good news to your mother.
It's also important to note that actinic keratosis most likely develops into Squamous Cell Carcinoma, while sometimes developing into Lentigo Maligna sometimes in the elderly. Lentigo Maligna is not the same, however, as Lentigo Maligna Melanoma. Lentigo Maligna is not invasive.
Either way which way, the biopsy on her left looks to be something that was very small and probably completely removed with the biopsy. Not sure about the right index finger. Has she been referred for further treatment for that?
Thank you for your response. I definitely do see how you are viewing the results. The PA went ahead and called the lab for a second opinion. The lesion on my mom's hand came back as a moderately dysplastic nevus and the one on her finger came back as a sun spot. I'm not sure if a sun spot and actinic keratosis is the same thing though. There is a difference of opinions here which really makes me nervous. Who do I trust?! Anyways my mom is going to get the lesion on her hand cut off but with a punch excision not a WLE. The lesion was very small and it is on her hand so the doctor recommended that. Also the procedure will be in October because my mom doesn't have a break until then. The doctor says that is okay but I'm worried leaving it that long. It was actively changing before she got it biopsied. So I'm worried that it was actively becoming malignant and we caught it in the process. Hopefully the lesion won't change and will be stable until then. What are your thoughts on leaving a moderately atypical mole and treating it with a punch excision? Thank you!
Most dermatologist prefer a punch biopsy/removal to a shave, so what your mother is undergoing is a good idea. The reason? A punch is like a cookie cuter - it goes down a little deeper into the skin and removes more tissue. Depending on the size of the mole, there might be quite a bit of skin taken and a stitch or two may be required, along with some numbing, but it's not all that bad. A shave biopsy/removal is where the mole is shaved off, with sort of like a razor. (Best description I can think of) Because it doesn't go very deep, there is concern if there is anything there, the shave won't go deep enough to get rid if. Also, sometimes shaving can leave a bit of scarring, where punch w/stitching doesn't.
As far as treating a moderately atypical mole with a punch? I'd be fine with that. I've actually had quite a few done post-melanoma. You have to keep in mind that anything removed from the skin is taken to a lab for biopsy just to be sure. And normally, with a punch biopsy, because it goes so deep, IF there was a possibility for anything showing up, it's probably gone with the biopsy. And a moderatly atypical mole is not the same thing as cancer - it means that it might someday in the future maybe become cancer - maybe. I think your mom will do just fine!