Back to the Pathology Report

Two weeks exactly after the mole biopsy, one week exactly after the diagnosis, I received the pathology report.  I used to like Thursdays.  Thursdays are the day before Fridays - Hooray!  Friday!  Good thing Fridays haven’t been infiltrated.  Anyways, back to the pathology report…

I asked Dr. Dermatologist to send me the pathology report for insurance reasons.  I luckily signed up for what is known as a “bridge” plan, similar to the insurance plan that has the Duck.  These types of plans will pay you “X” amount of dollars for services that you’ve had done, such as anything preventative.  I signed up for this 4 years ago - to which I was told that I wasn’t going to be approved because of my colitis.  Come to think of it, I don’t even remembering being told that I was approved. 

I had my annual woman exam, which is always a good time.  I remember my bridge plan and then started wondering if I just have an accident, hospital or cancer.  Cancer…wait a second - I have cancer.  Not a club I particularly wanted to join, but hey - now I am a member I will make the damn best of it.  I wonder what happens if I have had a biopsy like I did?  I wonder what happens if I am diagnosed, like I was?  Being the sleuth that I am, I go to their website and it does in fact say that they will pay upon initial diagnosis.  I start searching for bills that my company pays to confirm what plan I have.  I find it with the help of my manager.  Where’s my name??  There it is!!  Clear as day: Amber V and Shuggy V - Cancer Policy.  YES!  There is a light in this dark room that I’ve been thrown into.  Anyways, back to the pathology report.

I received the pathology report from Dr. Dermatologist and of course, as I’ve mentioned, I research as much information as I possibly can.  There are so many words that I don’t know.  Never missing an opportunity to learn something new, I dive right in:

            Type:                            Superficial spreading

            Clark’s Level:              At least III
            Breslow Level:             At least 0.5mm
            Vertical Growth:          Present
            Ulceration:                   None Identified
            Mitotic Rate:                Intermediate (3 per square mm)
            TIL:                              Present, Brisk
            Surgical Margins:         Present

The notes said that the tumor (which I can’t stand that word - it’s gross, isn’t it?) was basically cut off in the middle so the depth is estimated and will need to be adjusted upon further excision.  Based on my research, there are good and bad things with this report.  Let’s start with the bad…

Bad News Bears:         

Clark’s level at least III: This typically means that the tumor (shutter - hate that word) has basically completely penetrated the epidermis and more than likely the papillary dermis, too.  Of course, this will possibly need revision once the surgeon cuts more out.

Vertical Growth Phase: Since I was luckily was given the superficial spreading melanoma (as opposed to Nodular) this type begins growing outwards first and foremost.  Hence the “why the hell has this thing gotten so big” revelation.  This type grows across the epidermis first, then it begins to grow down further into the papillary dermis, then into the dermis…and finally wherever the heck it wishes via the lymph node highway.

Mitotic Rate: This is the rate in which infected cancer cells are dividing.  Apparently “good” would be less than one per millimeter.  I’m at 3 per mm; it’s an intermediate rate.

Good News Goons:

Breslow Level:  This is good, I’m under 1 mm - however, this is only based on the section of skin that was removed.  This can absolutely change once they perform the wide excision.

Ulceration:   There was no ulceration present which is essentially your skin breaking down due to the cancer.  This is when your skin swells, bleeds, sheds, etc.  My mole just looked like an oddly shaped dark mole, with an almost light/white halo around it.  No ulceration is good.  Ulceration is not good.

TIL (tumor infiltrating lymphocytes):  Wow, this scared the shit of out of me when I initially read it.  I took it as exactly how it reads - the tumor is infiltrating the lymphocytes.  WRONG.  This time, I was excited about being wrong.  What?  Who honestly likes being wrong?  What this actually means is the lymphocytes are infiltrating the tumor.  My body realizes there is an invasion.  There has been a security breach on my skin and these pasty cells are putting up a fight!

So, all in all, I know things can change upon the surgery.  I will have a wide excision on my back for them to take out more of the tumor (I’ve got to stop typing that word!).  It will be the shape of a triangle, or an eye.  This will help them sew it up because of the fact that the skin is typically pretty tight (unless you were pretty big, lost weight and now you have a bunch of excess skin - makes sense, right?).  And going back to the conversation from Dr. Dermatologist, they will need to look at some lymph nodes.  From there, we will find out what the next game plan will be.  I’m betting on Good News Goons to win the game! J