Biopsy question

shuggy1972 · Regular Joined: 31 Mar 2008 Posts: 28 Location: New York

Hi, looking for some advice in my quest to figure out what the heck is going on with my health...!

I joined this group in late March 08. Long story, but I had a 'suspect' mole on my left toe and was worried about melanoma.

After some great encouragement and support from people here, I ended up seeing two dermatologists. First one looked at it, and said 'probably fine'. That wasn't good enough for me, so I went to a second dermatologist who (as far as I could tell) seems to be an expert on skin cancer.

He agreed it looked suspect, but also said that he felt from all his experience that it was probably benign...but agreed to biopsy in any case.

After an anxious few days of waiting, I was very relieved when his nurse called to tell me that the pathology report had come back 'all clear'.

That was in early April. Since then I've been getting some other medical stuff checked out (including enlarged lymph nodes in my neck and a tightness at the back of my left knee) and I figured I'd be wise to get all my paperwork together...

So last week I collected a copy of the pathology report from my dermatologists office, and there was something that jumped out at me as odd:

"The specimen is received in formalin and consists of a shave biopsy of skin measuring 0.8x0.6x0.1 cm..."

I was under the impression that a SHAVE biopsy should NOT be used where melanoma is suspected/possible?

So does anyone on here know more details on this, and in particular:

1. Would the fact that the biopsy was SHAVE mean that it is possible/more likely that the pathologist mis-read the specimen as benign when in fact it was malignant? Why is a shave biopsy bad?

I'm now wondering if the dermatologist did the shave biopsy because the mole was in an awkward area to close with stitches and his hunch was that it was benign...

2. How common are false-negative errors in the diagnosis of melanoma - I read on the NCI site that they say patients 'may wish to consider a pathology second opinion because of the difficulty in diagnosing melanoma'....anyone got any more information on this?

I wouldn't be so worried about this if I didn't have the swollen lymph nodes and also have noticed in the past week or so that I'm getting frequent twinges of pain from the biopsy site, and there appears to be a darker area underneath the scar tissue over part of the biopsied area.

With all the other tests and doctors I'm seeing I'm reluctant to add yet another dermatologist and/or second pathology opinion into the mix, but I also don't want to assume all is fine if it isn't.

Sorry for the rambling message, any advice would be appreciated!

cheers

Euan

RacerX · Regular Joined: 01 May 2008 Posts: 19

I am FAR from an expert... so I'll only comment on one thing... the shaved biopsy.

From what I've read... the issue with them is that it doesn't always show how deep it is... which is a key issue with determining the stage of the melanoma.

I haven't read anything that would indicate a shaved biopsy would be less likely to show if it was melanoma or not... just the depth of it.

brainman · Posted: Wed Jul 02, 2008 11:58 pm Post subject: Re: Biopsy question

Euan, a shave biopsy will show whether or not it is/was a melanoma. The only problem is that if it had been positive, you would have had to had a second, or extensive resection of the area.

As for how often a false-negative error occurs, I do not know. You might want to follow the NCI's recommendation and have the sample reviewed by another pathologist.
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