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Dermatologist appointment

Forums General Melanoma Community Dermatologist appointment

  • Post
    vivian
    Participant

      Hello All,

      Hello All,

      I was recently diagnosed with nodular melanoma, currently staged 3a after PET/CT and SNB.  I am awaiting the CLND.  On Thursday I saw my dermatologist for the first time post diagnosis.  He did a simple full body check, without any special scopes, just his eyes.  At no point did he touch my skin (I would really rather he not touch me, but…).  Since my primary melanoma was atypical in that it was not differently colored or asymmetrical, shouldn't he have been more hands on, so to speak?  I am not feeling really confident in him since he did a shaved biopsy twice on this lesion, neither of which came back as melanoma, and by the time the excision was biopsied,  it was deep.  The SNB  was positive for one of two nodes.  The reading I have done on dermatology sites say that a shave biopsy should not be done on a suspected melanoma, so perhaps he wasn't wrong.  However, I am wondering what happens to all of you when you see your derms?  Do they just "look" ?  Since at this point I will be "watching and waiting", I want the watching to be really good.  I would love to hear what happens when you, my colleagues in this fight, visit the dermatologist. 

      Thank you and here's hoping everyone is having a wonderful Sunday,                                                                                                                                              Vivivan

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    • Replies
        A
        Participant

          I am sorry about your diagnosis.

          I have a lot of atypicals moles, so dermatologist uses dermascop to look at them. He usually doesn't use it on non-atypically looking nevi.

          You mentioned that your lesion was biopsied twice with negative results. I am wondering did they shave it off completely and then it grew back or did they remove just a portion of the "bamp". Still it is very strange that the results were "normal".

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          A
          Participant

            I am sorry about your diagnosis.

            I have a lot of atypicals moles, so dermatologist uses dermascop to look at them. He usually doesn't use it on non-atypically looking nevi.

            You mentioned that your lesion was biopsied twice with negative results. I am wondering did they shave it off completely and then it grew back or did they remove just a portion of the "bamp". Still it is very strange that the results were "normal".

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              vivian
              Participant

                It was very strange, and everyone, dermatologist, oncologist, hematologist, and surgeons are baffled by this.  The first biospy was "lichenoid keratosis" and the second was 'likely spindle cell melanocytic neoplasm".  The time between first and third biospy (nodular melanoma 4.35 mm) was less than two months.  He did shave the first off completely, I think, because the fact that it had grown back when I saw him two weeks later freaked him out and led to the second biopsy. 

                I am going to check out my options for other derms here.

                Thank you so much for your reply.  I really appreciate having all of you to talk to!

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                vivian
                Participant

                  It was very strange, and everyone, dermatologist, oncologist, hematologist, and surgeons are baffled by this.  The first biospy was "lichenoid keratosis" and the second was 'likely spindle cell melanocytic neoplasm".  The time between first and third biospy (nodular melanoma 4.35 mm) was less than two months.  He did shave the first off completely, I think, because the fact that it had grown back when I saw him two weeks later freaked him out and led to the second biopsy. 

                  I am going to check out my options for other derms here.

                  Thank you so much for your reply.  I really appreciate having all of you to talk to!

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                lhaley
                Participant

                  Vivian,

                  I've been to many derms over the years and they all seem to be a bit different. I've had 6 primaries and am stage IV. Only  1 time did I have a shave biopsy but it was close to my eye and was decided ahead of time that until we knew this was the safest way to go – it ended up being nothing.  My current derm uses a dermascope (I think that's what it's called) and has taken pictures to compare. He also checks my lymph nodes. I go to him every 3 months and he has set up my schedule to be between my onc appointments so there are eyes on my body every 6 weeks.  Not everyone goes that often but since I have dysplastic nevus syndrome I'm more likely to have more primaries.

                  Another question you didn't bring up is does your derm look everywhere?  Not that I want my body on display but melanoma doesn't just occur where the sun shines!

                  I noticed in your profile you are from Wilm. DE. That's where I grew up!!  Went to PS duPont while it was still a high school, then moved to Smyrna.  Now we live in SC.  I have gone to both Univ. of Penn's cutaneous melanoma clinic and Hopkins. Their derms are fantastic (or at least were when I was going there)!!

                  Linda

                  Stage IV since 06 NED 3 months (scans on Tuesday)

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                  lhaley
                  Participant

                    Vivian,

                    I've been to many derms over the years and they all seem to be a bit different. I've had 6 primaries and am stage IV. Only  1 time did I have a shave biopsy but it was close to my eye and was decided ahead of time that until we knew this was the safest way to go – it ended up being nothing.  My current derm uses a dermascope (I think that's what it's called) and has taken pictures to compare. He also checks my lymph nodes. I go to him every 3 months and he has set up my schedule to be between my onc appointments so there are eyes on my body every 6 weeks.  Not everyone goes that often but since I have dysplastic nevus syndrome I'm more likely to have more primaries.

                    Another question you didn't bring up is does your derm look everywhere?  Not that I want my body on display but melanoma doesn't just occur where the sun shines!

                    I noticed in your profile you are from Wilm. DE. That's where I grew up!!  Went to PS duPont while it was still a high school, then moved to Smyrna.  Now we live in SC.  I have gone to both Univ. of Penn's cutaneous melanoma clinic and Hopkins. Their derms are fantastic (or at least were when I was going there)!!

                    Linda

                    Stage IV since 06 NED 3 months (scans on Tuesday)

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                      vivian
                      Participant

                        Hello Linda,

                        What a coincidence – I grew up in Florence, SC and have lived in DE off and on for almost 40 years!  I will be thinking about you on Tuesday and "holding you in the light", as the good Quakers around here say.  The derm did check everywhere by sight (ugh), but I was thinking that since my primary melanoma was skin-colored, and I only found it from rubbing suntan lotion on my back and feeling the bump, maybe he should as well be feeling my skin.  He has never used a dermascope in all the twenty or so years I have been going to him.

                        Christiana Care here has grown enormously and has an excellent cancer center now.  Eight years ago I had a stem cell transplant that saved my life from a blood/bone marrow disease. That was done at CCHS, so I completely trust them. (I did have consults at Hopkins and Sloan back then and would do so again.)  It is probable that this melanoma is a secondary cancer to the chemo, radiation and immune suppressant that gave me those eight years.  I am very hopeful that I won't have a recurrence of the melanoma, but I am also not naive.

                        Thank you so much for answering my query – your signature alone makes me feel so much better.  Again, I will be thinking good, strong, positive thoughts about you on Tuesday!

                        Vivian

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                        vivian
                        Participant

                          Hello Linda,

                          What a coincidence – I grew up in Florence, SC and have lived in DE off and on for almost 40 years!  I will be thinking about you on Tuesday and "holding you in the light", as the good Quakers around here say.  The derm did check everywhere by sight (ugh), but I was thinking that since my primary melanoma was skin-colored, and I only found it from rubbing suntan lotion on my back and feeling the bump, maybe he should as well be feeling my skin.  He has never used a dermascope in all the twenty or so years I have been going to him.

                          Christiana Care here has grown enormously and has an excellent cancer center now.  Eight years ago I had a stem cell transplant that saved my life from a blood/bone marrow disease. That was done at CCHS, so I completely trust them. (I did have consults at Hopkins and Sloan back then and would do so again.)  It is probable that this melanoma is a secondary cancer to the chemo, radiation and immune suppressant that gave me those eight years.  I am very hopeful that I won't have a recurrence of the melanoma, but I am also not naive.

                          Thank you so much for answering my query – your signature alone makes me feel so much better.  Again, I will be thinking good, strong, positive thoughts about you on Tuesday!

                          Vivian

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                          Janner
                          Participant

                            I've had 3 primaries and have never had a derm "feel" my skin for melanoma.  Nodular is a strange beast in that it may be skin colored and grow quickly.  But I also never have relied on my derm finding my melanomas.  I've found my three.  I, personally, think YOU ought to be the one feeling your skin and you point out anything new/changing/unusual to your derm.  I will say that only a very small population — about 8% — of the melanoma population ever have more than one primary.  In reality, you run a higher risk of a recurrence from your original primary than you would finding a second melanoma primary.  You should be pointing out anything that is new/changing/unusual to your doctor.   My cutaneous oncologist just uses "sight" to look at my skin.  He does use a magnifier but that is basically for older eyes.  He has used a dermatoscope on me, but that is only on a lesion we both think is very suspicious.  He'll use that to take a closer look.  But, as I said, I really rely on myself to find anything unusual.  I know my body better than anyone.  

                            Best wishes,

                            Janner

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                            Janner
                            Participant

                              I've had 3 primaries and have never had a derm "feel" my skin for melanoma.  Nodular is a strange beast in that it may be skin colored and grow quickly.  But I also never have relied on my derm finding my melanomas.  I've found my three.  I, personally, think YOU ought to be the one feeling your skin and you point out anything new/changing/unusual to your derm.  I will say that only a very small population — about 8% — of the melanoma population ever have more than one primary.  In reality, you run a higher risk of a recurrence from your original primary than you would finding a second melanoma primary.  You should be pointing out anything that is new/changing/unusual to your doctor.   My cutaneous oncologist just uses "sight" to look at my skin.  He does use a magnifier but that is basically for older eyes.  He has used a dermatoscope on me, but that is only on a lesion we both think is very suspicious.  He'll use that to take a closer look.  But, as I said, I really rely on myself to find anything unusual.  I know my body better than anyone.  

                              Best wishes,

                              Janner

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                            washoegal
                            Participant

                              I have a similar problem with my Derm.  He seems to like to shave first and then cut.  I have asked him not to, but he still does.  I just had one removed from my bottom of my toe.  He said was a sun freckle, I said biopsy.  Not a sun freckle on the bottom of my foot.  He did a punch.  Came back "they don't think it's melanoma"  HUH??????   Waiting for results of the cut now.  If it comes back indeterminate I'll have the sample set to my Onc. 

                              It's frustrating, I suppose this this what derm's are taught.

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                              washoegal
                              Participant

                                I have a similar problem with my Derm.  He seems to like to shave first and then cut.  I have asked him not to, but he still does.  I just had one removed from my bottom of my toe.  He said was a sun freckle, I said biopsy.  Not a sun freckle on the bottom of my foot.  He did a punch.  Came back "they don't think it's melanoma"  HUH??????   Waiting for results of the cut now.  If it comes back indeterminate I'll have the sample set to my Onc. 

                                It's frustrating, I suppose this this what derm's are taught.

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                                ChristineL
                                Participant

                                  Hi,

                                  I was told by my surgeon that if my exam is not uncomfortable, they're not doing it right.  He/she should be looking between toes, in ears and mouth, on the scalp, etc.  all of which require some sort of hands-on approach.  Of course, you should be checking yourself as well, since you know your body better than him. 

                                  If it was me, since I have no tolerance for that, I would have called him on it right then and there.  But at the very least I'd look for someone that you are more comfortable with and someone who comes with recommendations.

                                  Good luck,

                                  ChristineL

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                                  ChristineL
                                  Participant

                                    Hi,

                                    I was told by my surgeon that if my exam is not uncomfortable, they're not doing it right.  He/she should be looking between toes, in ears and mouth, on the scalp, etc.  all of which require some sort of hands-on approach.  Of course, you should be checking yourself as well, since you know your body better than him. 

                                    If it was me, since I have no tolerance for that, I would have called him on it right then and there.  But at the very least I'd look for someone that you are more comfortable with and someone who comes with recommendations.

                                    Good luck,

                                    ChristineL

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                                      vivian
                                      Participant

                                        Thank you all for your replies!  Something just doesn't feel quite right with my current derm, so I am going  forward with finding another one who is  more cautious and maybe more experienced with melanoma.

                                        Best regards,

                                        Vivian

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                                        vivian
                                        Participant

                                          Thank you all for your replies!  Something just doesn't feel quite right with my current derm, so I am going  forward with finding another one who is  more cautious and maybe more experienced with melanoma.

                                          Best regards,

                                          Vivian

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