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Not sure what to think…

Forums Cutaneous Melanoma Community Not sure what to think…

  • Post
    alysoy
    Participant
      I’ve been following these forums for quite a while, but I’ve decided to make a new account today. I’m 27, male and have a family history of skin cancer. My dermatologist wanted to biopsy 2 moles from me yesterday that was concerned about. Notably, there was one on my arm that was an “ugly duckling”. The scary part about this, is that it is a new mole that grew very very little in the span of 1 year/1-1/2 years, and it’s very dark. Definitely stands out from the rest of my moles that are brown. Now i’m extremely anxious over the idea that this ugly duckling simply can’t be anything other than Melanoma.

      Do ugly ducklings like this usually always end up being Melanoma? Or has anyone experienced a dark mole that was an ugly duckling that came back fine? It started out as a tiny pin dot, and grew double that size but seemed to have stopped growing since that. It was perfectly symmetrical, one solid color (dark dark brown or maybe black), didn’t itch or bother me at all. I also have a few darker moles on my leg that have bene there for years (although my derm didn’t check my lower body during this check). Is it also possible that if my body can create dark moles, even if they are just a few, that I have the ability to create them somewhere else and them be completely normal? I just don’t know what to think. Biopsy results won’t come back for another week or 2, and that might be the hardest part.

      It seems as if the Ugly Duckling rule is a classic sign for something sinister and bad. The fact that my derm suggested that one go away because it was “an ugly duckling” has me prepping for bad news. I’m just conflicted, because the mole didn’t look anything like the ugly pictures you typically see. I’d appreciate any opinions/feedback, i’m just currently trying to control my anxiety in the meantime.

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    • Replies
        TarlieT
        Participant
          Hi Alysoy,

          Good for you for staying on top of your skin checks and having anything concerning checked out. I am very familiar with this anxious waiting period, and it’s crazy/scary how the two possible outcomes–it’s nothing at all, or it’s something dangerous that requires action–like at such different extremes.

          I’m not a clinician or melanoma researcher, but here’s my take on your question: the ugly duckling strategy is a really valuable one for identifying melanomas, since the ABCDEs can cause misses–my melanoma, for example, was pink, symmetrical, dome-shaped, and even-bordered (nodular melanoma)…and so both I and the numerous dermatologists I saw assumed it was nothing dangerous. For anyone interested, here’s a nice JAMA article on the effetiveness of the ugly duckling approach: https://jamanetwork.com/journals/jamadermatology/article-abstract/2600689

          But, all of that said, my (again, non-expert) guess would be that many ugly ducklings turn out not to be melanoma. They might be dysplastic nevi, basal cells (not ideal but not melanoma), etc. I am a bit of a special case because my body makes numerous “populations” of moles–so they’re not very consistent-looking in general–but I can’t tell you how many ugly ducklings I have had removed based on the derm’s recommendation, but which came back as just a little atypical. Of over 20 biopsies in my life, all conducted at good institutions and at the recommendation of the derm, just the one has ever been anything but a dysplastic nevus or normal mole.

          It sounds like it’s good that you had it removed–the cons of a biopsy seem so small compared to the potential gains–but that you can also have solid hope that it’ll turn out to be nothing, or almost nothing. The fact that it’s been growing very slowly and not itching or bleeding seems like good news (although a caveat is that, if it happened to be nodular melanoma–which it very hopefully won’t be!–they do tend to grow vertically/deep rather than horizontally across the skin).

          Focusing on controlling your anxiety makes a lot of sense, since you can’t influence the outcome at this point anyway. Depending on what works for you, maybe try some meditation, distraction, exercise, social time, or even thinking through the worst-case scenario and how you’d tackle it (this freaks some people out but it helps me feel in control :).

          I hope this is somewhat helpful,
          Tarlie

            alysoy
            Participant
              Thank you so much for replying!! I’ve had one “ugly duckling” removed on the side of my back which came back moderately atypical, so it was fine. However, it was brown like my other moles. This one scares me because it’s darker than any of my other moles except a few on my legs (including a dark mole I consider a birthmark that I’ve had ever since I was a kid, which I will also have my derm look at my next appointment) and that’s why it’s been freaking me out. All I hear is “black is bad” for moles. It definitely grew very slowly and even seem to stop growing after a while, it was only 2mm in diameter, maybe even less. Is it normal for new moles to appear and grow very slightly and then stop?

              Can nodular moles be flat, or tiny tiny bit raised? This one wasn’t really raised much, if at all. I love the advice of mediation and distraction, that’s exactly what I need right now. Really appreciate the response TarlieT. I sure hope it comes back normal.

              TarlieT
              Participant
                I know darker moles can be a worrisome indicator–and are definitely worth keeping a close eye on and biopsying as appropriate–but I will say that I’ve had a number of black spots that have either been removed and turned out fine or that we’ve left because they don’t look problematic under the dermatoscope. Again I’m not a clinician, but it sounds like you and your docs made the right decision to biopsy, *and* that you have a lot of reason to hope that all will be fine.

                To your question about growth: I’m honestly not sure. What I’ve been told is that cancer likes to grow, to divide, so that you’re often going to see worrisome things changing. But of course there are exceptions, like when the mole is growing vertically into the epidermis, which you probably couldn’t see with the naked eye. That said, you and I are in our late 20s, and from what I’ve been told it’s normal to develop new moles throughout your 20s–so maybe this is just your body continuing to produce new moles, growing them to a particular size, and then stopping.

                My sense of nodular melanoma is that it tends to be, well, nodular–like a bump or dome. Here’s an article that reinforces that: https://www.medicalnewstoday.com/articles/323599.php#signs-and-symptoms So if your mole was flat or just slightly raised, it sounds like nodular likely wouldn’t be of concern for you…which would be great!

                My fingers are crossed for you! I know the wait can feel endless, but in a few weeks or less this could all be behind you :).

                – Tarlie

                alysoy
                Participant
                  My dermatologist also reassured me that it’s completely normal to get moles in my 20’s and 30’s. I really appreciate the kind words. I’ll update when I get the results back!
                JudiAU
                Participant
                  I think you just have to wait for the pathology and know that very few miles are melanoma. I have a lot of weird moles and even with stage IV melanoma they are still on my body.
                    alysoy
                    Participant
                      You’re definitely right. I have no control at this point, just have to wait to see what the pathology report comes back as. Are you doing immunotherapy by any chance for your Stage IV? Sending all the good vibes your way.
                    Treadlightly
                    Participant
                      I am a 9 year survivor of stage 2A Melanoma, and since my diagnosis, I have had multiple suspicious moles removed during my many regular skin check appointments. One in particular stands out to me because it was remove solely because it was the darkest mole on my body. It was not particularly large, but it appeared almost black. I remember my doctor saying “let’s get that out of here.” It turned out to be absolutely nothing.

                      Waiting for biopsy results is the absolute worst. I recommend that you do everything you can to distract yourself from thinking about it…and absolutely do not do any Google searches. There is no point in fretting about something that is very, VERY unlikely to actually happen.

                      Best of luck to you on getting good news!
                      Mark

                        alysoy
                        Participant
                          Thank you very much, Mark. Waiting is indeed the worst. I really appreciate your encouragement. Congrats to 9 years, and cheers to many many more!
                        lkb
                        Participant
                          Waiting is hard. So hard that I have been known to politely inquire about results sooner rather than later. I’m reasonable and kind and sometimes get results earlier than initially promised. Wishing you the best!
                          alysoy
                          Participant
                            Update: My dermatologist called with the results, both moles came back benign and showed as mild atypical. None the less, a happy call! Scheduling a full body skin check to make sure no other suspicious spots are around.
                              Treadlightly
                              Participant
                                Hey,

                                Congratulations on the awesome news! Now…go out and live your life to the fullest!!

                                Best wishes for a long & healthy life,
                                Mark

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