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Differential diagnose of Atypical spitz tumor and spitzoid melanoma…confused.
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Differential diagnose of Atypical spitz tumor and spitzoid melanoma…confused.

› Forums › General Melanoma Community › Differential diagnose of Atypical spitz tumor and spitzoid melanoma…confused.

  • Post
    • February 23, 2014 at 1:16 am
    Kelly Smith
    Participant

      I am a 29 year old mother of 2 boys, 7 and 3, and in 2 weeks I will be induced with my 3rd, a little girl named Ava. This all started with what I was told was a "bug bite" 8 months ago…It just appeared one day. NOTHING like what you would expect melanoma to look like. Fast forward to Jan. 7th of this year. I did not feel right about this bump, which was still there, not growing, but would itch from time to time. I had a new dermatologist look at it, and she also said that it was nothing. I insisted that she take it off and have it biopsied. I did not think that it was melanoma, but I didn't like it. I got a call 2 weeks later, Jan. 20th, stating that it was melanoma. There is a differential disagnosis of atypical spitz nevus, atypical spitz tumor, and spitzoid melanoma. So, I saw a surgical oncologist, who did the WLE, and SNB on Jan. 29th, with me being 32 weeks pregnant. Frozen section said negative for melanoma…big sigh of relief. BUT…On Jan. 31st, we got the phone call that there were actually "rare single and small groups of cells in one sentinel node." What a complete bummer. The biggest focus was 0.3mm.  Regardless, there was something found in the lymph node, which puts me at 3a…I cannot have PET/CAT scans done until my daughter is born. I am a WRECK. Now my question is…my dermatologist and a family member of mine who is also a dermatopaholoist have both said that my diagnosis can actually be "somewhat less aggressive than a convenional melanoma." Has anyone else heard this? The breslow depth was 1.45, non-ulcerated, no mitotic rate was specified, although I know that there were some cell seen in mitosis.I am just so confused. I have also researched that fact that atypical spitz tumors can and do metastasize to lymph nodes. So the whole differntial diagnosis thing is really really confusing to me. I am not saying that I don't inded have melanoma, I am just so confused. I know that many people who are 3a stay that way, and some don't. I am realistic. Also I'm a wreck, and at times I feel like it's the end of the world. I would really really really appreciate any info. that you all can give me. Thank you…

    Viewing 8 reply threads
    • Replies
        • February 23, 2014 at 5:45 am
        Zan
        Participant

          Hi Kelly,

          If I were in your position I would insist on a second opinion from a melanoma specialist (different than a dermatologist who has seen some melanoma – you actually want someone who specializes in mel and has seen lots of melanoma and also spizoid melanoma). You don't want to underestimate it – or overestimate it.

          While there are many who do not have additional problems from spizoid melanoma, my family member did, and so I think it is important to get as much information as you can from those who know about it the most. That way you can make the best, informed decision possible and not be in unnecessary fear.

          Congratulations on your baby – my hope is that you can start the process of getting an opinion from another specialist and in the meantime concentrate on this wonderful time of life with your baby. Hang in there!

           

           

           

          • February 23, 2014 at 5:45 am
          Zan
          Participant

            Hi Kelly,

            If I were in your position I would insist on a second opinion from a melanoma specialist (different than a dermatologist who has seen some melanoma – you actually want someone who specializes in mel and has seen lots of melanoma and also spizoid melanoma). You don't want to underestimate it – or overestimate it.

            While there are many who do not have additional problems from spizoid melanoma, my family member did, and so I think it is important to get as much information as you can from those who know about it the most. That way you can make the best, informed decision possible and not be in unnecessary fear.

            Congratulations on your baby – my hope is that you can start the process of getting an opinion from another specialist and in the meantime concentrate on this wonderful time of life with your baby. Hang in there!

             

             

             

              • February 23, 2014 at 12:05 pm
              Kelly Smith
              Participant

                Thanks Zan! I am going to do just that. You are right, and I'd much rather be agressive than not, but I'm just really confused. Thanks again for the advice..

                • February 23, 2014 at 12:05 pm
                Kelly Smith
                Participant

                  Thanks Zan! I am going to do just that. You are right, and I'd much rather be agressive than not, but I'm just really confused. Thanks again for the advice..

                  • February 23, 2014 at 12:05 pm
                  Kelly Smith
                  Participant

                    Thanks Zan! I am going to do just that. You are right, and I'd much rather be agressive than not, but I'm just really confused. Thanks again for the advice..

                  • February 23, 2014 at 5:45 am
                  Zan
                  Participant

                    Hi Kelly,

                    If I were in your position I would insist on a second opinion from a melanoma specialist (different than a dermatologist who has seen some melanoma – you actually want someone who specializes in mel and has seen lots of melanoma and also spizoid melanoma). You don't want to underestimate it – or overestimate it.

                    While there are many who do not have additional problems from spizoid melanoma, my family member did, and so I think it is important to get as much information as you can from those who know about it the most. That way you can make the best, informed decision possible and not be in unnecessary fear.

                    Congratulations on your baby – my hope is that you can start the process of getting an opinion from another specialist and in the meantime concentrate on this wonderful time of life with your baby. Hang in there!

                     

                     

                     

                    • February 23, 2014 at 3:39 pm
                    Janner
                    Participant

                      Send your biopsy and SNB slides to Boris Bastian at UCSF.  He is well versed in spitz vs melanoma.  Another recent posts about this and POW posted his contact info.  Since spitz can look identical to melanoma under the microscope, you want an expert reviewing your slides.  Spitz is typically found in people under 20 but it is still worth having the slides reviewed by experts.

                        • February 23, 2014 at 4:34 pm
                        Kelly Smith
                        Participant

                          Hi Janner, the 2nd opinion was sent to UCSF. Dr. Leboit is the one who have the diagnosis of spitzoid melanoma. First diagnosis was inflamed spitz tumor…I know that Dr. Leboit is very good at what he does, I am just still thrown by the whole "3 differential diagnoses" thing. I was told by my dermatologist that b/c of my age they have to go with spitzoid melanoma.

                          • February 23, 2014 at 4:34 pm
                          Kelly Smith
                          Participant

                            Hi Janner, the 2nd opinion was sent to UCSF. Dr. Leboit is the one who have the diagnosis of spitzoid melanoma. First diagnosis was inflamed spitz tumor…I know that Dr. Leboit is very good at what he does, I am just still thrown by the whole "3 differential diagnoses" thing. I was told by my dermatologist that b/c of my age they have to go with spitzoid melanoma.

                            • February 23, 2014 at 4:34 pm
                            Kelly Smith
                            Participant

                              Hi Janner, the 2nd opinion was sent to UCSF. Dr. Leboit is the one who have the diagnosis of spitzoid melanoma. First diagnosis was inflamed spitz tumor…I know that Dr. Leboit is very good at what he does, I am just still thrown by the whole "3 differential diagnoses" thing. I was told by my dermatologist that b/c of my age they have to go with spitzoid melanoma.

                            • February 23, 2014 at 3:39 pm
                            Janner
                            Participant

                              Send your biopsy and SNB slides to Boris Bastian at UCSF.  He is well versed in spitz vs melanoma.  Another recent posts about this and POW posted his contact info.  Since spitz can look identical to melanoma under the microscope, you want an expert reviewing your slides.  Spitz is typically found in people under 20 but it is still worth having the slides reviewed by experts.

                              • February 23, 2014 at 3:39 pm
                              Janner
                              Participant

                                Send your biopsy and SNB slides to Boris Bastian at UCSF.  He is well versed in spitz vs melanoma.  Another recent posts about this and POW posted his contact info.  Since spitz can look identical to melanoma under the microscope, you want an expert reviewing your slides.  Spitz is typically found in people under 20 but it is still worth having the slides reviewed by experts.

                                • February 24, 2014 at 6:45 am
                                Ali
                                Participant

                                  They send out my slides to UCSF to have them unravel the DNA and determine if it was melanoma or spitz nevus.  It was melanoma.  If you personal message me I would give you my number if you wanted to chat about what I've heard from different doctors about the spitoid melanoma (don't feel like I can type it out right now).  One of my suregons did believe they were less aggressive than other melanomas.  I don't know, mine has been pretty aggressive, but it has responded to treatment.  They found my mole when my kids were young and it is so very scary.  Best wishes to you!

                                  Ali

                                  • February 24, 2014 at 6:45 am
                                  Ali
                                  Participant

                                    They send out my slides to UCSF to have them unravel the DNA and determine if it was melanoma or spitz nevus.  It was melanoma.  If you personal message me I would give you my number if you wanted to chat about what I've heard from different doctors about the spitoid melanoma (don't feel like I can type it out right now).  One of my suregons did believe they were less aggressive than other melanomas.  I don't know, mine has been pretty aggressive, but it has responded to treatment.  They found my mole when my kids were young and it is so very scary.  Best wishes to you!

                                    Ali

                                    • February 24, 2014 at 6:45 am
                                    Ali
                                    Participant

                                      They send out my slides to UCSF to have them unravel the DNA and determine if it was melanoma or spitz nevus.  It was melanoma.  If you personal message me I would give you my number if you wanted to chat about what I've heard from different doctors about the spitoid melanoma (don't feel like I can type it out right now).  One of my suregons did believe they were less aggressive than other melanomas.  I don't know, mine has been pretty aggressive, but it has responded to treatment.  They found my mole when my kids were young and it is so very scary.  Best wishes to you!

                                      Ali

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