Need clarification on Squamous Cell Carcinoma pathology results?!
Question: I had a squamous cell carcinoma in situ removed. The path report shows "the atypia extends out along the basal cell layer focally to one lateral margin...this atypia may represent an early evolving area of the lesion." My GP says the results are unclear because the report did not say it had clear margins.
Does this mean not all of the carcinoma was completely removed? Does it mean we should just watch the spot? The spot removed was 2.6 x 0.8 x 0.2 cm, but grew from non-existent to that size in just 2 weeks. The skin around the scar is red and rashy looking...like not other scar I've had.
The report further stated "in the epidermis there is a broad poorly circumscribed area showing acanthosis with marked keratinocytic atypia, lack of maturation and increased mitoses involving the full thickness of the epidermis. No demal invasion is identified.
Can anyone clarifiy if this should be a wait and see situation or if I need to have more tissue removed? Do I need to see a specialist?
Answers: I had a squamous cell carcinoma in situ removed. The path report shows "the atypia extends out along the basal cell layer focally to one lateral margin...this atypia may represent an early evolving area of the lesion." My GP says the results are unclear because the report did not say it had clear margins.
Does this mean not all of the carcinoma was completely removed? Does it mean we should just watch the spot? The spot removed was 2.6 x 0.8 x 0.2 cm, but grew from non-existent to that size in just 2 weeks. The skin around the scar is red and rashy looking...like not other scar I've had.
The report further stated "in the epidermis there is a broad poorly circumscribed area showing acanthosis with marked keratinocytic atypia, lack of maturation and increased mitoses involving the full thickness of the epidermis. No demal invasion is identified.
Can anyone clarifiy if this should be a wait and see situation or if I need to have more tissue removed? Do I need to see a specialist?
"The atypia extends out......to one lateral margin" means that one of the margins of the specimen was not clear/still involved the atypical cells. You need to go back to the gp or surgeon who did the first excisional biopsy and have another excision with wider margins until you get a path report that specifically states that the margins were clear. Do not wait and see, your report clearly states that you had an involved margin.
Add: You could also have your doctor call the pathologist and have him/her take another look at your slides and clarify your results.
Because of the atypia (unusual) extending to one of the margins (edges). They can't say if all the cancer has been removed or not. It may mean another will grow. I think you need to watch it very closely and have your doctor or a dermatologist look at it if anything is unusual, like your scarring. I don't think you need to worry about the last part with the acanthosis and keratinocytic atypia, but hopefully someone else more knowledgeable will let you know.
I would go to a dermatologist. Take a copy of the report with you.
I've had way too much experience with squamous cell skin cancers and in my opinion you have one of two possible situations happening.
(1) Because of the very rapid growth and the pathologist's description it is possible that the type of squmaous cell that you had was a Keratoacanthoma, a rapidly growing cancer that is considered an invasive subtype of squamous cell carcinoma. I had one that grew from a 2mm red dot to a 1cm tumor in 9 days. My derm said this type of SCC typically grows quite quickly for a month or so and then sort of implodes and breaks up and usually goes away on it's own. Of course no one wants to take the chance that such a rapidly growing and ugly skin cancer does not implode, does become invasive and then spreads elsewhere so of course I had it removed immediately with wide margins. My Dr said there was a small chance of recurrence but that this would happen quickly if it was going to recur. Fortunately the first excision cured my squamous / keratoacanthoma.
Here are a couple web pages that discuss keratoacanthoma.
http://www.orlandoskindoc.com/keratoacan...
http://www.emedicine.com/derm/topic206.h...
I have read that in some countries that Keratoacanthoma are considered benign and not a squamous cell carcinoma subtype but according to the two very smart American dermatologists that I spoke to about mine, a Keratoacanthoma is a subtype of SCC and since it grew so quickly, I wanted it off quickly. No messing around.
Here is another, somewhat convoluted description of a Keratoacanthoma as found on Wikipedia.
http://en.wikipedia.org/wiki/Keratoacant...
I think I'd have my Dr call the pathologist and see if they can give you any clarity about their description and whether or not they would classify your SCC as a Keratoacanthoma.
(2) The second explanation regarding your situation is as described by D. The original excision did not get a clear margin in that one area or the excision went right down to the margin with no room at all for error. In this case you would want to have a second excision done to get a deeper margin.
I think I'd go for having a deeper margin taken. I know what a pain it is to have to have a new excision done on an area that just took a month to heal but if you have the deeper margin taken then you can quit worrying about this.
Your alternative would be to immediately start treating the area where your excision was located three or four times a week with the immune modifier cream Aldara. If there are any cancer cells remaining then you will quickly notice infllammation from your immune system reacting against the malignant cells. You would keep applying the Aldara for 4-6 weeks until their was no longer any reaction happening or until you decided to have a deeper margin excised. Since you do not have prior experience using Aldara cream then the simpler solution for you would probably be to get the deeper excision done.
You do not need a specialist as long as your dermatologist is taking your concerns seriously and is willing to work with you.
good luck which ever way you go