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Shahid Karim
Shahid Karim, Board Certified MD
Category: Medical
Satisfied Customers: 1824
Experience:  MBChB
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I have just had the following come back from a report done

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Hi. I have just had the following come back from a report done here in Spain (so this is translated from the Spanish):
JA: What are all your symptoms? Are you taking any medication?
Customer: Pathology Report – 13th May 2022 (Initial biopsy performed on 26th April, 2022)Immunohistochemical report (IHC) of Melan A, HMB45 and P16.Microsocopic Description.Immunohistochemical study of Melan A positive for melanic cellularity with pagetoid migration; HMB45 negative for infiltration y loss of stain of P16.Diagnostic:Biopsy (skin sample):Melanoma in situ of malignant lentigo (Clark Level 1).Size of the tumour: 3.5mmMargins of resection: The lesion has one of its lateral resection surgical margins in contact.In the overall dermis there exists minimal fibrosis and inflammatory perivascular lymphocytes and intersticial (regressive signs of less than 75%).Staging: Tis = In Situ cancer (according to what I am reading Tis translates as follows: Tis means that the cancerous cells are reproducing at the uppermost level of the skin where the tumour began, without invading the skin further down. This may refer to a tumour or to in situ cancer.
JA: Got it. Have you seen a dermatologist about tumor?
Customer: The first dermatologist cut into the tumour as he was extremely negligent. I am interested in knowing how much damage that could cause as I know melanoma is aggressive and the type I have, extremely aggressive. I have an appointment on Thursday to remove more of the skin surrounding the original mole
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Doctor should know?
Customer: I have a history of extensive sunbathing and all too often burning (a few occasions even with blisters). Mainly from the age of 18 onwards (I am now 45) I don't take any medication and have no other health issues
Customer: replied 6 days ago.
File attached (7S2P51Q)

Good afternoon, thank you for getting in touch. Could you tell me a little more about what you'd like to discuss? I may take a few minutes to reply as dealing with other patients too, thank you

If you could give me a minute or two I will look over the results and be right with you

Customer: replied 6 days ago.
Ok, thank you

Your assessment of the situation is correct in that there is some remaining cancer tissue likely present at one of the edges from the resection, i.e. a little more could have been resected and so the upcoming extra resection is exactly what is required. Given how recent it is it's actually unlikely that any significant further growth has occurred or indeed any damage caused and so I would be pleased that it appears only a tiny piece remains and that it will undoubtedly be resected at the upcoming appointment which the next histology report should be able to confirm.

Customer: replied 6 days ago.
Thank you, ***** ***** definitely put my mind more at ease. I didn't understand why the level was only 1 (Clark Level) and yet when I have put in the size of the melanoma into Google it says 3.5mm is Stage 2B or even Stage 3 (depending on other factors). Isn't this contradictory? And by the Dr cutting into the mole, does that not mean it can send cells into the bloodstream too?

No that's very unlikely as this is still quite superficial and it's not the deepest edge that has the cancer remaining but rather the lateral edge. 

Of course, you're always welcome and I'm glad I could help in any way. Do come back if you've any other questions and have a wonderful day.

Customer: replied 6 days ago.
with regard to the size of the melanoma. If something is a melanoma and is in situ, does the size become redundant?

Yes the in situ literally means in place, i.e. localised to there only.

Customer: replied 6 days ago.
the size doesn't matter then?

Well in so much as much larger lesions tend to be deeper as well then it can matter but yours has been resected deep enough, it's the edge that needs extra resection if that makes sense.

Customer: replied 6 days ago.
I am afraid I don't really understand that! I understand the first point, but not that mine has been resected enough?

It's the side edge of the lesion that remains with some cancer tissue, not the bottom/under edge, as in, it's been resected deep enough but more was needed from the side so that remaining cancer tissue is still superficial not deep

Customer: replied 6 days ago.
One final point and then I am done (thank you by the way, as you are definitely helping put my mind at ease). This same Dr has, at various points, cut off other pink nodule things from my back and never sent them off for analysis. I now am doubting his abilities given that he was very haphazard about taking this mole off (he did it within about 1 minute of me walking into the surgery and pointing it out and did it very fast and was very dismissive saying it was 'probably nothing'). is there any way I can know if those previous nodules etc were melanoma or do I just have to wait? I have had my skin checked by another dermatologist in the meantime and the rest of my moles look normal (even though I have also subsequently discovered that most melanomas actually don't appear in moles). I am now just a bit paranoid given this doctor (I also found out, from various reviews online which I wish I had read before), that many others had complained about his manner and way of just whining off moles. I just wondered what would happen in the case of one of those moles/pink nodule things having been a melanoma if a mole would then come back to replace it? I know that's very hard to answer, I just wondered if you knew anything about that! And then I am done, I promise!
Customer: replied 6 days ago.
whipping off not whining!

That's quite alright. It would be difficult and I think the only way would be to monitor the sites of those previous resections but if they picked up this melanoma I imagine they likely would have suspected it there if typical in appearance which they usually are but as with any lesions, monitoring them, the site and surrounding skin is what is critical. I do hope that was helpful.

Shahid Karim and 2 other Medical Specialists are ready to help you
Customer: replied 6 days ago.
Thank you. You have been super helpful and helped me sleep this weekend before I go in to see the other dermatologist next week. Have a nice weekend :-)

Of course, you're always welcome and I'm glad I could help in any way and that's very kind of you to say. Do come back if you've any other questions and have a wonderful day.