Keratosis vs. Melanoma

There are two types of keratosis that come to mind, you description needs more clarification. 

Seborrheic keratosis.  Often times weird looking even to the point they can look like melanoma.  They can look ugly, but they typically have a "top" on them that is quite identifiable.  Freezing isn't always the best option because SKs can come back even after freezing.  I personally would not have one of these frozen especially if it was on my back – is it that cosmetically problematic that you can't live with it?  Instead, I would either demand a biopsy or take pictures and monitor it for change.  Freezing it destroys it but doesn't answer any questions and it may just come back.  SKs are totally benign and often show up as people age.  I have quite a few and I know what they are and are just living with them.

The other type of keratosis often seen in those with melanoma is actinic keratosis.  These are precursors for squamous cell carcinoma.  They are often rough patches, scaly, or sores.  These can be frozen and destroyed or biopsied.  Freezing or topical chemo cream can usually take care of these before they become something worse..

YES! That is how my journey started. Although mine was diagnosed by my PCP, not a dermatologist.

I had a roundish, raised spot on my lower back. My PCP looked at it and said "That looks like a seborrheic keratosis." He was the same doctor who a few years before had sent me to have two suspicious spots on my back removed, and one of them came back as "precancerous" so I figured he knew what he was talking about, even though I had another keratosis on my hip for years and the two looked nothing alike.

At the time dermatologists were hard to come by in my area, and to be honest I trusted my PCP much more than the one dermatologist who was around here, and who had diagnosed my wife's lesions from porphyria as "bug bites." I largely put it out of my mind.

My wife, who is an RN, could see the spot on my back much better than I could, and after watching it grow to the point where it had begun to look almost like a jelly bean, she insisted that I return to my PCP and demand that it be taken off. My PCP was still sure it was nothing, but he removed it in his office. A week later I went back to have the stitches removed and the nurse put my chart on the counter next to the exam table. The word "melanoma" leapt off the page at me. He called the surgeon while I was in the room and when he told the surgeon that the depth was 6mm I could hear the reply even with the phone up to my doctor's ear. "SIX MILIMETERS?!?!?!" The bad feeling I had immediately got worse.

That was January of 2013. After surgery to get the margins my PCP missed and a sentinel lymph node biopsy I was classified as stage IIIb. I'm now stage IV and I'll always wonder whether things would have been different had the nodule been removed sooner. If you have any questions at all about your dermatologist's assessment, get another opinion!

-Bill

Yep, I was originally diagnosed to have a sebhorric keratosis…. only to find out many months later it was melanoma. My whole story is in my profile if you'd like to read, but I will always go with "if it makes ME uncomfortable, no matter what the doc says, biopsy the sucker". 

My derm will not freeze anything anymore.  Everything I mention or he finds go directly to a biopsy.  When I mention freezing, his response is always "not with your history".  As an fyi, most of the time it has been cancer (squamous).  I had one biopsied last fall and I was surprised in came back as keratosis.