Melanoma Pathology

  • Richard Cheney, MD, Professor, Chair, Department of Pathology & Laboratory Medicine

Why the Roswell Park Doctor You Never Meet May Be the Most Important Person on Your Care Team

Cancer patients see many doctors during the course of their treatment, but rarely do they meet the specialist who plays the most critical role in their outcome: the pathologist who diagnoses their cancer by analyzing samples of blood, tissue and body fluid. Precise diagnosis is what drives all subsequent decisions about treatment options and other patient choices.

The melanoma pathologists at RPCI are highly specialized and have received extensive training in the field of dermatopathology (the study of skin cancers). They directly review all of the pathology slides from your biopsy (whether it was performed at RPCI or by an outside physician) and render an expert opinion on the key characteristics that will define your melanoma treatment.

The RPCI Difference

Pathology is the most important aspect of a cancer diagnosis, explains Dr. Kane.

RPCI is the only provider in the Western New York region that offers a full molecular pathology service, fast-tracking diagnosis and avoiding delay in commencing treatment. This includes the following key pathology studies:

  • Immunohistochemistry study – By adding an antibody, dye, or radioisotope to the sample of cancer cells, the pathologist looks for certain antigens or proteins, that help identify even small deposits of melanoma in biopsy specimens or potential targets for cutting-edge therapies
  • Light and electron microscopy – Cells are viewed using a high-powered microscope to look for changes characteristic of melanoma
  • DNA sequencing – Process that determines potential mutations in melanoma cells that may be a target for newer therapies

Game-Changer

Roswell Park pathologists have reported a 10 percent change in overall cancer diagnoses that were made outside of Roswell Park.

Second Look, World of Difference

Even if all you need is a second opinion from Roswell Park, we’re here for you!

A second opinion is the best way to reassure you that your initial diagnosis of melanoma is accurate and the recommended treatment strategy is right for you! Over a century, our specialists have successfully worked with community doctors, and are happy to discuss and share information, as needed.

When Should You Seek a Second Opinion?

It’s always a good idea, but especially important if:

  • Your physician or pathologist has not provided you with a full, clear explanation of your pathology report, in a language you understand.
  • Your physician tells you that you don’t need a second opinion. A good doctor will suggest that you get another opinion if there are questions about your treatment or diagnosis. If your physician is offended, find a new doctor.
  • Your physician wants you to have surgery tomorrow. Almost nothing in the world of cancer care requires that kind of immediacy, except patients with acute leukemia; cases in which a tumor is compressing a vital structure, such as the heart or large blood vessels; or certain other rare conditions. 

If you’re still not sure whether to ask for a second opinion, ask yourself:

  • Am I confident in the diagnosis or treatment options I’ve been given?
  • Am I comfortable with my treating physician?
  • Has my physician clearly explained all treatment options – not just the ones he or she prefers?
  • Are there clinical research studies offering new treatments for my cancer?
  • Was my cancer diagnosed at an office or community hospital setting or in a comprehensive cancer center?
  • Does my insurance plan require a second opinion? If not, what type of coverage does it provide for second opinions?

To arrange for a second opinion, call 1-800-ROSWELL (1-800-767-9355) or fill out the online Become a Patient Form.

Your Melanoma Pathology Report

Key terms detailed in your pathology report include:

  • Breslow thickness – How deep (in millimeters) the tumor has grown
  • Ulceration status – whether or not the tumor’s top skin layer has eroded
  • Clark level – a score that refers to tumor depth by which skin layer is invaded
  • Dermal mitotic rate – the number of growing tumor cells
  • Peripheral margin status – whether any cancer cells remain in the tissue surrounding the sides of the tumor
  • Deep margin status – Whether any cancer cells remain in the tissue under the tumor
  • Microsatellitosis – tiny tumors are found near the main tumor
  • Tumor location – where in the body the main tumor developed
  • Tumor regression – tumor size decreased
  • Tumor infiltrating lymphocytes – whether any white blood cells were found in the tumor
  • Vertical growth phase – tumor grows down, deeper in the skin
  • Angiolymphatic invasion – cancer spread to lymph or blood vessels
  • Neurotropism – cancer cells were found in the nerves
  • Histologic subtype – the cancer type based on cell characteristics
  • Pure desmoplasia – whether there is dense connective tissue

Cancer treatments are becoming more and more targeted, so an accurate and comprehensive analysis by a pathologist is critical in determining the best approach. Learn more about how to read your pathology report.