Excision of 17 Atypical Nevi I have history of Melanoma

My experiene with mole mapping was NOT a single time.  It was baseline mole mapping and then at each followup appointment, the same moles were photographed.  The software did a comparison and both the derm and I did a visual on-screen comparison.  We removed moles that changed, not moles that the software deemed were a risk.  We didn't even use that aspect of the software that I recall.  I don't have tons of moles but all my biopsies have been atypical to some degree.  Mole mapping was designed for people like you with lots of atypical moles, but just relying on the mole mapping software on what to remove isn't the best solution.  It should be a collaborative effort with the derm and you using the software as a tool, not as an authority.  Now, I just use baseline photographs because I don't have tons of moles.  We only remove moles that change.

Dematopathologists can certainly tell the difference between melanoma and other moles.  However, it's an art as much as a science.  For atypical moles, there is essentially a scale.  You look at the lesion and start adding up atypical features.  The more you have, the more atypical.  There is a point when some of the factors point to melanoma instead of atypical.  It isn't an exact science and you will get different diagnoses from different docs – that's why you want your slides to go to a dermatopathologist who sees melanoma all the time. 

I've had three primaries and I am seen every 6 months.  That schedule will not change.  I don't have DNS but I do have a genetic defect that puts me at very high risk for more primaries.

My experiene with mole mapping was NOT a single time.  It was baseline mole mapping and then at each followup appointment, the same moles were photographed.  The software did a comparison and both the derm and I did a visual on-screen comparison.  We removed moles that changed, not moles that the software deemed were a risk.  We didn't even use that aspect of the software that I recall.  I don't have tons of moles but all my biopsies have been atypical to some degree.  Mole mapping was designed for people like you with lots of atypical moles, but just relying on the mole mapping software on what to remove isn't the best solution.  It should be a collaborative effort with the derm and you using the software as a tool, not as an authority.  Now, I just use baseline photographs because I don't have tons of moles.  We only remove moles that change.

Dematopathologists can certainly tell the difference between melanoma and other moles.  However, it's an art as much as a science.  For atypical moles, there is essentially a scale.  You look at the lesion and start adding up atypical features.  The more you have, the more atypical.  There is a point when some of the factors point to melanoma instead of atypical.  It isn't an exact science and you will get different diagnoses from different docs – that's why you want your slides to go to a dermatopathologist who sees melanoma all the time. 

I've had three primaries and I am seen every 6 months.  That schedule will not change.  I don't have DNS but I do have a genetic defect that puts me at very high risk for more primaries.

My experiene with mole mapping was NOT a single time.  It was baseline mole mapping and then at each followup appointment, the same moles were photographed.  The software did a comparison and both the derm and I did a visual on-screen comparison.  We removed moles that changed, not moles that the software deemed were a risk.  We didn't even use that aspect of the software that I recall.  I don't have tons of moles but all my biopsies have been atypical to some degree.  Mole mapping was designed for people like you with lots of atypical moles, but just relying on the mole mapping software on what to remove isn't the best solution.  It should be a collaborative effort with the derm and you using the software as a tool, not as an authority.  Now, I just use baseline photographs because I don't have tons of moles.  We only remove moles that change.

Dematopathologists can certainly tell the difference between melanoma and other moles.  However, it's an art as much as a science.  For atypical moles, there is essentially a scale.  You look at the lesion and start adding up atypical features.  The more you have, the more atypical.  There is a point when some of the factors point to melanoma instead of atypical.  It isn't an exact science and you will get different diagnoses from different docs – that's why you want your slides to go to a dermatopathologist who sees melanoma all the time. 

I've had three primaries and I am seen every 6 months.  That schedule will not change.  I don't have DNS but I do have a genetic defect that puts me at very high risk for more primaries.

I went to a melanoma symposium a while back and here are some notes I took from the doctor that oversees the mole mapping program at my institution.  This data is quite a few years old and I'm sure they have updates but this is what I have now.

50% of melanoma arise from existing moles.

6% of melanoma diagnosed is from an unknown primary.
 

I went to a melanoma symposium a while back and here are some notes I took from the doctor that oversees the mole mapping program at my institution.  This data is quite a few years old and I'm sure they have updates but this is what I have now.

50% of melanoma arise from existing moles.

6% of melanoma diagnosed is from an unknown primary.
 

I went to a melanoma symposium a while back and here are some notes I took from the doctor that oversees the mole mapping program at my institution.  This data is quite a few years old and I'm sure they have updates but this is what I have now.

50% of melanoma arise from existing moles.

6% of melanoma diagnosed is from an unknown primary.
 

Ah. I thought so. Molemate, as I understand it, uses a fairly notoriously unreliable algorithm. Melanoma detection is not broadbrush, it's a calculated clinical decision based on a combination of ABCDE criteria, and the ugly duckling criteria (you can google them). What I've heard is that the molemate system is kind of an inferior way to detect melanoma. For example:

http://www.bmj.com/content/345/bmj.e4110

Conclusion: We found no evidence that the MoleMate system improved appropriateness of referral. The systematic application of best practice guidelines alone was more accurate than the MoleMate system, and both performed better than reports of current practice. Therefore the systematic application of best practice guidelines (including the seven point checklist) should be the paradigm for management of suspicious skin lesions in primary care.

I stand by my earlier advice to get a 2nd opinion. Your age does not come into it, really – kids get melanoma, young adults, middle age, older… Diameter is just one variable and really needs to be assessed alongside other characteristics (in particular: new or changing moles). You can be overly cautious and go ahead and do this, but I find it clinically dubious and personally would get a 2nd opinion.

One thing I've learned, like Janner says, is that you are your own best detection – I found all of mine, because they changed OR set off alarm bells in some vague way that I can't really pinpoint (perhaps chagned so imperceptibly that it triggered my interest but I couldn't really put my finger on it). I think you need a 2nd opinion and six monthly checks. If this means changing doctor then so be it, because I find 17 excisions and 1 yearly checks to be odd clinical practice. Better than nothing, but odd.

Ah. I thought so. Molemate, as I understand it, uses a fairly notoriously unreliable algorithm. Melanoma detection is not broadbrush, it's a calculated clinical decision based on a combination of ABCDE criteria, and the ugly duckling criteria (you can google them). What I've heard is that the molemate system is kind of an inferior way to detect melanoma. For example:

http://www.bmj.com/content/345/bmj.e4110

Conclusion: We found no evidence that the MoleMate system improved appropriateness of referral. The systematic application of best practice guidelines alone was more accurate than the MoleMate system, and both performed better than reports of current practice. Therefore the systematic application of best practice guidelines (including the seven point checklist) should be the paradigm for management of suspicious skin lesions in primary care.

I stand by my earlier advice to get a 2nd opinion. Your age does not come into it, really – kids get melanoma, young adults, middle age, older… Diameter is just one variable and really needs to be assessed alongside other characteristics (in particular: new or changing moles). You can be overly cautious and go ahead and do this, but I find it clinically dubious and personally would get a 2nd opinion.

One thing I've learned, like Janner says, is that you are your own best detection – I found all of mine, because they changed OR set off alarm bells in some vague way that I can't really pinpoint (perhaps chagned so imperceptibly that it triggered my interest but I couldn't really put my finger on it). I think you need a 2nd opinion and six monthly checks. If this means changing doctor then so be it, because I find 17 excisions and 1 yearly checks to be odd clinical practice. Better than nothing, but odd.

Ah. I thought so. Molemate, as I understand it, uses a fairly notoriously unreliable algorithm. Melanoma detection is not broadbrush, it's a calculated clinical decision based on a combination of ABCDE criteria, and the ugly duckling criteria (you can google them). What I've heard is that the molemate system is kind of an inferior way to detect melanoma. For example:

http://www.bmj.com/content/345/bmj.e4110

Conclusion: We found no evidence that the MoleMate system improved appropriateness of referral. The systematic application of best practice guidelines alone was more accurate than the MoleMate system, and both performed better than reports of current practice. Therefore the systematic application of best practice guidelines (including the seven point checklist) should be the paradigm for management of suspicious skin lesions in primary care.

I stand by my earlier advice to get a 2nd opinion. Your age does not come into it, really – kids get melanoma, young adults, middle age, older… Diameter is just one variable and really needs to be assessed alongside other characteristics (in particular: new or changing moles). You can be overly cautious and go ahead and do this, but I find it clinically dubious and personally would get a 2nd opinion.

One thing I've learned, like Janner says, is that you are your own best detection – I found all of mine, because they changed OR set off alarm bells in some vague way that I can't really pinpoint (perhaps chagned so imperceptibly that it triggered my interest but I couldn't really put my finger on it). I think you need a 2nd opinion and six monthly checks. If this means changing doctor then so be it, because I find 17 excisions and 1 yearly checks to be odd clinical practice. Better than nothing, but odd.