Case Number : Case 2139 - 21 August 2018 Posted By: Uma Sundram

I do not like the looks this new breast lesion.  I considered spitzoid features but not sold on that.  Could be dysplastic nevus, modérate to severe.  However, I am worried that this could be a melanoma.  Not sure based on these photos. Depending on what deeper cuts and/or intradepartmental consultation yields, I might do Myriad Mypath study for extra data.

2 hours ago, Alice Roberts said:

I do not like the looks this new breast lesion.  I considered spitzoid features but not sold on that.  Could be dysplastic nevus, modérate to severe.  However, I am worried that this could be a melanoma.  Not sure based on these photos. Depending on what deeper cuts and/or intradepartmental consultation yields, I might do Myriad Mypath study for extra data.

Alice,

Heard a lot of Myriad mypath testing from you. Is that something that you use when you have a difficult melanocytic lesion?  I guess you send tissue to the lab for genetic testing. How is the billing?  Do the insurances pay for the test?  And how helpful it is based on your personal experiences?

They bill the patient, I believe.  We don’t have any financial involvement with them and only use on consensus difficult lesions.  It’s more data but doesn’t trump histology case by case.  Occasionally a lesion will test indeterminate and warrant FISH analysis.  The company (Myriad) representatives  are pleasant to deal with and very reasonable. You can call and talk to them.  We do a few a month probably.  

This is the test:

https://mypathmelanoma.com/about-mypath-melanoma/

Ordering page:

https://mypathmelanoma.com/about-mypath-melanoma/ordering-process/

Thanks for the information 

Melanoma. 

Large bizzare nests of melanocytes with nuclear atypia. I think this is nested melanoma.

We were quite concerned about melanoma as well. Given the location on the breast, we were not sure as to how much of the atypia was site related, so fell short of a definitive diagnosis. We recommended a complete excision with follow up of this atypical lesion.

I think it is melanoma too

I'd certainly withhold a firm diagnosis as this is a partial biopsy of a challenging lesion on a special site without important clinical details size, dermoscopy, suggested clinical diagnosis etc. If it was clinically concerning it should have been excised fully with a clear margin (I always suggest 2 to 3mm beyond any faint pigmentation whenever possible). Given that it's very thin I don't think there is any risk for metastasis so I'd put it in the  SAMPUS (superficial atypical melanocytic proliferation of uncertain significance)  group.