Disclaimer: I do not have melanoma BUT my dermatologist had me very concerned that I did for a while.
Let's start at the beginning. Some time in August I went to my PCP about a weird skin thing I'd had on and off for about three years. She could not identify it so she sent me to a dermatologist. Miraculously, I was able to see that dermatologist the same day. She took one look at me and diagnosed me with confluent and reticulated papillomatosis (CARP). This is an uncommon type of dermatitis that is easily treated. On a follow up visit I made the mistake of wearing shorts. From across the room this woman spotted a suspicious mole on my leg, completely ignoring my other moles. This was not my largest or ugliest mole but she concluded it was suspicious and needed to be removed. She performed a shave biopsy and sent it off to the gross room at Ruby. I just so happen to work in the gross room at Ruby and have access to my cassettes and slides.
Figure 1: My shave biopsy, inked, bisected and embedded
Figure 2: H&E stain of my biopsy
Figure 3: Positive special stain for BRAF, a proto-oncogene
The results of my mole did indeed come back as suspicious (see below) so I was scheduled to have a skin excision in case there was melanoma hiding in my severely atypical nevus.
Figure 4: Gross description and diagnosis
The skin excision was an interesting experience. As a red head I am aware that anesthetics do not work well on me. My dermatologist was kind enough to believe me when I told her that and gave me a double dose of lidocaine for both the biopsy and excision. Sadly that double dose was not enough for the excision and they had to give me yet another shot after I reported that I could feel them suturing my remaining skin back together. Overall, I wouldn't want to do it again but it could have gone a lot worse.
Figure 5: My skin excision fresh off my leg
Figure 6: Skin excision inked, serially sectioned and embedded
Figure 7: Gross description of skin excision
It was determined that the mole was entirely removed and harbored no melanoma. Yay! According to my dermatologist, lower leg wounds have a hard time healing and often become infected which leads to wound dehiscence. My leg wound in particular did not have enough skin to close the gap left from the excision. The remaining skin was pulled too tight and died due to inadequate blood supply. It subsequently became infected but is now healing well. The scar will be approximately 4.5 x 1.3 cm and will take about 3 months to heal.
As both a PA student and gross room employee I found this entire experience to be fascinating. I got to see the path of a surgical pathology specimen from start to finish and I didn't have cancer which is super cool. It highlighted for me the importance of this job. It took 10 days to get the result for my biopsy after which I had to wait a month before my excision. The excision results came quickly since they didn't do any special stains but in total it was about 6 weeks of waiting to see if I had cancer. This was a relatively small case and the stakes were not super high. Even if it had been melanoma it would have been caught early and likely cured by the excision. Now imagine what it would be like to be a patient waiting to hear back about something serious and your results are delayed or inaccurate because the PA did a bad job grossing. All I can say is treat every specimen with the same care that you would treat your own and consider seeing a dermatologist every now and then.
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