Biopsy report says carcimona both low risk and very high risk?

Bluemeany

Hi Emma and a very warm welcome to the skin cancer group which I hope you'll find is both an informative and supportive place to be.

Although I have had both malignant melanoma and basal cell carcinoma (BCC) I haven't had squamous cell carcinoma (SCC) so don't have any experience of being told that the SCC is both "very high risk and low risk at the same time".

Have you been assigned a SCNS (skin cancer nurse specialist) sometimes known as a key worker? If so, my best advice would be to give them a call on Monday and ask them to explain your diagnosis again. If you don't have a SCNS then give your consultant's secretary a call and ask for your consultant to give you a call so that he can explain what this all means.

Do come back and let us know what they say as it'll be useful if anyone comes here in the future with the same question.

x

Hi Emma,

could you please tell us what exactly did your doctor tell you about the risk.

Thanks for the reply. Having spoken to my doctor today, it seems to be that the cancer itself overall is low risk (because it's well differentiated and easy to treat), but the depth of the cancer is the very high risk part... so that's what the report meant; one is appraisal of overall situation, the other is an analysis of one particular feature of the carcimona, in this case the depth. 

I've had further surgery today to remove it; so hopefully that will deal with now! Just got to wait for this next bioposy report. :-) 

Thank you. I've mentioned a bit more below, but having spoken to my doctor, it seems the low risk part referred to the overall situation, where as the 'very high risk' classifcation was for just one particular aspect of the carcimona, in this case the depth. 

Because of what the first biopsy found out about the width and the type (well differntiated), the overall analysis of the carcinoma is it's low risk. e.g. the width, type and form (squamous cell) are all low risk. Add my age and medical history in to the mix - and the report says it's a 'low risk' situation. The part that was 'very high risk' was the depth, but that one very high risk feature wasn't enough to change the overall classification of the carcimona. 

I'm pleased to hear that you now know what the report means Bluemeany and that you've had surgery to remove it completely.

I'll be keeping my fingers crossed that that will be the end of it now

It is great it was removed! Could you please tell me what kind of surgery you had? Was it just a simple removal in a doctor office or was it done in a hospital (mohs surgery)?

It wasn't Mohs, no. For info and for benefit of anyone else with similar thing:

The first surgery I had few weeks ago was just a simple shaving removal in a dermatologist's office. When the biopsy came back however, it said there was a clear 2mm clear margin for width of carcimona, but that depth wise there was 'a very high risk' the cancer was still there because there was no clear margin depth wise. (This is where my confusion on the 'low risk/ very high risk' classifacton written on bioposy report came from). 

The second surgery I had yesterday was still in dermatologists office, but was more involved than the first. The doctor took away much more tissue down to the layer just above the bone ( I can't remember the names of the exact layers), but all in all I think it took max 40 minutes, and most of that time was the doctor doing the stitches. 

The doctor explained that basically, after the first removal/ biopsy came back with the info that the cancer is deeper but width wise we had clear tissue, my options were:

1. Full removal of tissue down through all skin and sub fat layers: PROs: 1. likely to be sure of getting all the cancer still remaining. CONs: Will leave a scar and its a second minor operation, so there's negligible chance of infection etc.

2. Radiotherapy: which wouldnt leave a scar but doctor 100% wouldn't recommend for low risk carcimona at this point.

3. Do nothing. Again, doctor wouldn't recommend but he said it is a choice a patient has. Overall, it's low risk, well differentiated cancer, so even though depth was high risk, we could 'wait and see'. Apparently, he said in 1/3 of paitents who choose to have removal of more tissue like I did, the second biopsy comes back with no cancerous cells at all... meaning there was no need to have the second surgery. Sometimes this will be because the first surgery did in fact get all the cancer - there just wasn't any safety margin to confirm that. Or, the other possibility is, that after the first surgery, the amount of cancerous cells left in skin was so low, that the body then managed to deal with those cells by itself. 

I chose the full removal of tissue because I need to be sure all the cancer is gone. It's also what the doctor reccommended and what he considered medically best practice.

For anyone else in similar situation: I personally would still go for the surgery having had it. The operation itself was fine. Obviously, I'd rather not have it - but imo getting a filing or tooth removed at the denists is worse. My head does hurt a little today, but no more than for the first 'shaving' removal.

Your experience is interesting. Thank you for sharing! Do not worry about the star. BTW how big it is? I have never heard about doing such an extensive surgery in a doctor office. You did the right thing to do the surgery.

I had 3 CSS removed, two from my face and the last one from my hand. The one on the hand grew right back after it was removed, and now she referred me for mohs with waiting list more than a month!  She said I could go to hand surgery if I wanted , but the waiting list is the same. I read a study which says that the risk of CSS on the hand to reoccur and to go to other parts  is greater than for the same tumor on the head. So I believe my waiting time is way too long, counting that the initial tumor grew rapidly and was described as invasive and that my immune system is compromised.

Sorry to hear that the tumour in your hand came back Br44. That's bad luck. 

The squamous cell carcimona I had was 0.7mm wide when I had it removed. Like you, it grew rapidly. It appeared and grew to that size from nothing in about 3 weeks. 

I did have to wait about 4 weeks too for the initial removal and biopsy. Like you too, I was also concerned by all the waiting. What helped me, was phoning the McMillian helpline and speaking to one of the nurses. She went through all the info about the diagnosis with me that I could tell her, and then reassured me that, in her opinion too, because it was well differentiated, there was no real harm to me in waiting a few weeks. 

Obviously, from what you're saying given that you've been told it's invasive and have a compromised immune system, that may not be the same situation for you. But it might be worth phoning and chatting to a nurse to get an independent opinion on how long is safe to wait for surgery? It definitely reassure me talking to her. 

I live in the USA, so no option to call a nurse. I doubt anybody could tell how long is too long to wait. This cancer could get life threatening in two-three weeks, and could grow for years and never cause any problems. I have been reading scientific studies about this. 
Could  you please tell me how many stitches did you get? I am asking because I saw some pictures before and after the surgery with a small spot before and a huge stitches after.