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.
Questions to Ask Your Doctor When Diagnosed
The doctor’s findings are included in a pathology report. The report states whether cancer was found, and if so, what type of cancer. It is a good idea to ask for a copy of the pathology report.
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)
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 bringing a family member or friend to your appointments who can take notes, so that you may concentrate on listening to your doctor.