Question on biopsies

[angiem62]

I am a 43 yr old F - in good health. Recently I had a squamous cell carcinoma removed from the right side of my scalp. At the same time I showed him what appeared to be a mole behind my right ear, and another "thing" from the right side on my back.  He biopsied both. It has now been 20 days since the biopsy and he called to say "The preliminary findings are they are atypical and could be internal cancer, however at this time they are not showing any specific organ."  Ok what does all this mean?  Am I in deep trouble here......or is this just what they say until they know more?  He says since all are on the right side, it may not be a good thing.  I had a mammogram 3 mos ago - all is normal - blood tests look good - white count just a tad bit elevated. Please answer soon, I am going nuts with worry.  Thanks!!

[Alan Rockoff, MD]

The story as you tell it makes little sense.  First, why should it take 20 days?  Second, if the findings "could be internal cancer," the proper course would be to perform more biopsies at once. For a skin biopsy to show "internal cancer" is an extremely rare phenomenon in any case.

If I were you, I would call tomorrow and demand a full and comprehensible explanation at once.  If one is not forthcoming, I would find another consultant and request that the pathology slides be forwarded to another laboratory for confirmation.  If the doctor you've been dealing with is a surgeon, you need to consult a dermatologist.

You have worried enough.  You should expect clarification at once.

Best.

Dr. Rockoff

[angiem62]

I asked for a copy of the report.  Keraton AE1/AE3 : The cells of the dermal lesion are positive. CD31- staining is confined to capilliary endothelium the cells of the dermal are negative. CD68,HMB-45 - the cells of the dermal lesion are negative.  S100 staining is confined to dendritic celss the cells of the dermal lesion are negative.  The 2nd tests that were run show the following...Adjacent to a zone of necrosis are strands of cords of highly atypical undifferentiated cells.  Immunohistochemical studies performed at the University of Cincinnati Dept of Pathology reveal these cells to be positive for pancytokeratin and negative for CD31,CD68,S-100 and HMB-45.  This is consistent with infilitrating carcinoma.

Clinical:  R/O SCC
and the other says
Clinical: SCC vs cutaneous met vs lymphoma vs leukemia

Due to the presence of multiple lesions and pattern.  This is suspicious for a mesatsis.  

Diagnosis:  Infiltrating carcinoma consistent with mestasis.

So basically what I am being told is this: "The lesions we have removed and/or biopsied are the result of an internal cancer."
So what they are saying is I have something cancerous internally and it worked out to these lesions???

Now you may understand my panic and concern..........

[Alan Rockoff, MD]

That is indeed what the report seems to be saying.  I certainly understand your concern.  May I ask why you aren't discussing this with your own doctors?  I think you should.

Dr. Rockoff