› Forums › Cutaneous Melanoma Community › Atypical but still melanoma in situ?
- This topic has 4 replies, 2 voices, and was last updated 5 years, 3 months ago by
markmsn.
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- January 23, 2019 at 2:38 pm
This is the same type of post that many many others have asked. I just need some real advice or reassurance. I had a small tiny mole 1mm x 1.5mm in size in front of my ear. I think it was there 10 years ago by photos but not as dark as it has been in the past few years. I decided to have it looked at. It did not fit any of the ABCDE rules really except it was darker brown and did not seem to ever change in size.
I had a shave biopsy done and the dermatologist said she was 98% sure it was benign before the pathology report came below:
– ##################MICROSCOPIC INTERPRETATION##################
– Skin, left preauricular, shave:
– ?????- Atypical junctional melanocytic proliferation, extending to the lateral edge.
– Comment: Sections show a small but poorly nested junctional melanocytic proliferation with focal upward scatter into the epidermis in heavily sun-damaged skin. The findings are most consistent with early/evolving melanoma in situ.
–I'm guessing the ????? is the diagnosis line and was lost in the fax but here are my questions:
She called me back on the results and said "You have a benign atypical nevus…. but there are some changes on slide 2 and you need a wider excision"
I was fine with that news– so I went to a Mohs surgeon three weeks later and he sat down with me and bluntly said "Lets call this a Melanoma in Situ" then continued to refer to it as cancer. Also stating that a stray cancer cell could have gotten out and to watch for signs of metastesizing. Although rare he said it does happen. I continued to ask him about the pathology report from the original biopsy and said that it was leaning more towards a melanoma so that would be his thought.
So I went through the 5mm procedure and have a nice 2" scar down my left ear but they said "All margins are clear"
So what does this mean to me? Do you think I actually had melanoma or was this just an atypical nevus that may or may not have become one? The stray cell the Dr. talked about seems almost impossible based on my research of both atypical and melanoma in situ. Thoughts?
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- January 23, 2019 at 2:50 pm
Based upon the info you've provided, I'd say it was severly atypical, but evolving into melanoma in situ. It's a bummer to have a 2 inch scar, but certainly sounds like you made the right preventative move. As for metastasis….. it is unlikely, but never discount anything as nearly impossible. Keep your eyes everywhere on your skin. It has already proven once that it is unpredictable.
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- January 23, 2019 at 5:25 pm
Thanks for the quick reply? I guess I only have a problem with "Did I in fact have cancer or just atypical cells" I know the treatment is the same between atypical and Situ and I will follow up every 3 months with my dermatologist.
I guess living with a cancer diagnosis albeit only Stage 0 is what weighs on me. I'd rather it be atypical in the peace of mind. I just want an honest opinion and not scared of the truth. Its just that after the surgeon mentioned "Calling it in Situ" but in the same breath "Treating it as if it is Melanoma in Situ" Then later saying "Cancer cells are gone" Sigh– I guess I can check back with my dermatologist in 2 months for my checkup. She was just a PA but had been practicing there a long time and felt confident in calling it a benign-Atypical lesion with borderline/evolving melanoma.
Thank you so much for your time!
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- January 25, 2019 at 2:51 pm
The pathology isn't exceptionally clear. Hopefully your derm can be more solid with an answer, but from what was put into th report, it seems as though even the pathologist wasn't absolutely certain as to how to define it. An aggressive thinking path might have posted "in situ", whereas another might see it more as "severely atypical". Either way, you needed those clear margins. Maybe think of it as a severly atypical nevus with a really bad attitude… like a rebellious 1950's teen in a leather jacket. 😉 LOL! That mole was one bad decision away from being labeled a criminal. ha! To your mohs surgeon's credit, listing it in your medical records as the "worse" of the two potential diagnosis, is probably more helpful, as this will keep docs more alert and on their toes due to your "prior melanoma diagnosis". It also helps justify any potential future excisions to your insurance billing.
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- January 25, 2019 at 7:43 pm
Thank you! I appreciate the response– he did take the full 5mm around it. Actually took that additional around the original biopsy so slightly more. I imagine my derm will schedule my 3 month appt sometime soon and will ask those questions. She was pretty adamant about the atypical diagnosis but understand how pathologist might differ and definately agree that the Mohs surgeon take the 5mm vs 3mm for a severe atypical lesion. Thanks again for the insight and taking time to answer my questions!
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Tagged: cutaneous melanoma
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