Understanding your Pathology Report
A pathologist is a doctor who evaluates cells and tissues to diagnose disease. The pathologist examines the biopsy sample under the microscope to diagnose melanoma. In the pathology laboratory, the biopsy specimen is prepared for examination. The sample is embedded in wax, sliced very thinly, and stained with dyes. The stain helps the doctor see the cells clearly. Preparing the sample in the laboratory usually takes one to two weeks. Sometimes a dermatopathologist, a doctor who specializes in diagnosis of diseases of the skin, also examines the biopsy sample. This may take extra time.
The report also contains other information that may include the terms below. If there is anything you do not understand, ask your doctor.
- How thick the melanoma is (Breslow index)
- Presence of any skin ulceration (ulceration status)
- How deep the melanoma has grown (Clark level). The larger the level number the deeper into the tissue it extends. Depending upon where the melanoma is located on the body, the millimeters of depth for each Clark level can vary widely, so one person’s Clark’s III may be 1 mm, while another person’s is 2 mm.
- Clark’s Level I—lesion involves the dermis
- Clark’s Level II—lesion involves the papillary dermis
- Clark’s Level III—lesion invades and fills the papillary dermis
- Clark’s Level IV—lesion invades reticular dermis
- Clark’s Level V—lesion invades sub-cutaneous tissue
- How fast the melanoma cells are growing and dividing (mitotic rate)
- Presence or absence of melanoma cells in the normal tissue around the lesion (peripheral margin status)
- Presence or absence of melanoma cells in the normal tissue under the lesion (deep margin status)
- Presence of tiny tumours near the primary melanoma (microsatellitosis)
- Location of the melanoma (tumour location)
- Size of the melanoma (tumour size)
- Decrease in tumour size (tumour regression)
- Presence of white blood cells in the melanoma (tumour-infiltrating lymphocytes)
- Growth of the melanoma down into the skin (vertical growth phase)
- Growth of melanoma around nerves (perineural invasion)
- Melanoma type based on features of the cells present (histologic subtype)
- Presence or absence of dense connective tissue (pure desmoplasia)
(“Understanding your Pathology Report”. Melanoma Network of Canada.)
It is very important for you to understand what the pathology report says about your melanoma. Pathology results help determine treatment options.
Upon diagnosis and after you have had a chance to review this new information, it is important to become an active participant in your treatment. Begin by bringing a family member or friend to your appointments who can take notes, so that you may concentrate on listening to your doctor.
More information about melanoma staging can be found here.
New treatments are tested in clinical trials before they are approved for general use. There are safeguards in place to ensure clinical trials are as safe as possible and meet medical ethical standards. Participating in a trial can be a way to have access to potentially helpful new therapies you couldn’t get any other way.
Clinical trials are funded by pharmaceuticals evaluating their new treatments. Therefore, the treatments, tests, and doctor visits are usually paid for and patients are followed very carefully.
Clinical trials usually have very specific criteria for the patients who can participate, such as severity or stage of disease and whether and what types of previous treatments you have had.
If you are found to be eligible, most studies will not allow you to choose whether you will be put into the group of patients given the existing standard treatment or the group receiving the new medicine. Often, neither you nor your doctor will be told which treatment you are receiving.
This randomization of what you are assigned to, and blinding of you and your doctor to the treatment you are getting, is an important part of ensuring clinical trials are as free from bias as possible and therefore, ensures the results are as clear as possible.
If you are interested in participating in a clinical trial, ask your doctor if there are any appropriate studies available to you.
Finding clinical trials
You can find out about trials for melanoma or other skin cancers from the following website: www.ClinicalTrials.gov.
It’s operated by the United States National Institutes of Health which keeps track of studies being conducted for all types of diseases around the world. Search for trials for your specific cancer and location to see what studies might be open to you, then discuss them with your doctor.
Health Canada operates a similar database for Canadian studies, accessible here.