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Please help me out here, so confused by biopsy and recommendations.
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Please help me out here, so confused by biopsy and recommendations.

› Forums › Cutaneous Melanoma Community › Please help me out here, so confused by biopsy and recommendations.

  • Post
    • January 15, 2016 at 2:49 am
    Rlukas79
    Participant

      There is so much conflicting information about severe atypical Moles vs melanoma in situ. 

      my pathology report says Severe Atypia and was confirmed by other dermopathologists at the lab. The original derm I used says to me not cancer but severe and just get it excised in about a month or two. 

      i had already planned switching to another derm that just has a much better foundation for their practice. I brought the pathology report to him and he broke it down for me on the malignancy and benign spectrum. Instructed me that of course severe moles have to be excised like melanoma, 5mm margins. Still insisted that I have no other concerns as he did a skin check two weeks ago and that a yearly visit is all that I need. My history with moles is mixed

      1 severe atypia December 2015

      2 moderate atypia, 2014 and 2009

      1 moderate to severe Atypia 2010

      and 5 mild Atypia 2009 and 2014

      with this history should I be doing bi yearly visits?

      i have no more atypical moles just normal moles scattered from my back (5 or so)

      and about 25 on my legs. These are all normal. 

      My derm says that while I may think that's a lot of moles and taking into consideration the ones that were removed and properly excised, he doesn't deem me as even a moderate risk. I'm fair skinned. 

       

      My family doctor says Severe might as well be melanoma in situ because labs will under diagnose sometimes.  I thought it was the exact opposite. Over diagnose MIS rather than severe Atypia when it's just to hard to tell. Or refer to it as severe Atypia starting to evolve into MIS. 

       

      So my questions refer to am I high risk and do bi yearly screenings?  And Is severe Atypia really just MIS?  If the normal risk of melanoma is 2% for an average Caucasian, anyone have an idea what it is for people that have varying degrees of Atypia?  

      Thanks i was just bringing the anxiety down and my Family doctor of all people raised it back up. At least she gave me Xanax. 

    Viewing 5 reply threads
    • Replies
        • January 15, 2016 at 2:51 am
        Rlukas79
        Participant

          Pathology report reads:

          Junctional melanocytic nevus with elongated. fused rete ridges and concentric lamellar fibrosis within the underlying papillary dermis.
          A mild superficial dermal lymphocytic infiltrate is identified.  Cytologic atypia is severe.
           
          The whole path report reads:
          The lesion appears to be completely excised, but is close 
          to a lateral (peripheral) inked edge.  Conservative
          re-excision is recommended to ensure all atypical melanocytes are removed.
          Immunohistochemical staining was performed using Melan-A (A specific marker of Melanocytes)
          to ascertain the degree of melanocytic hyperplasia and presence of intraepidermal melanocytes.  Aprropriate postive and negative controls were 
          performed.  Melan-A primarily stained lentiginous cells along the elongated rete with occasional pagtoid cells.  These findings support the above histological diagnosis.
          [b]THIS CASE WAS REVIEWED AT THE DAILY INTRADEPARTMENTAL CONFERENCE…..[/b]
           
           
          So the Derm says the prior damage (nair chemical burn and ruptured the mole pretty good andTook a few months to heal) definitely could have played into the architectural and cytologic atypia but the problem is, it doesnt matter.  Can't be proved but not ruled out. Understandably when a cell is atypical it's atypical, it doesn't matter how it got that way.  It could have been a normal mole, could have been a mildly atypical mole etc.  Regardless iIt's severe and needs to come out.
          • January 15, 2016 at 2:51 am
          Rlukas79
          Participant

            Pathology report reads:

            Junctional melanocytic nevus with elongated. fused rete ridges and concentric lamellar fibrosis within the underlying papillary dermis.
            A mild superficial dermal lymphocytic infiltrate is identified.  Cytologic atypia is severe.
             
            The whole path report reads:
            The lesion appears to be completely excised, but is close 
            to a lateral (peripheral) inked edge.  Conservative
            re-excision is recommended to ensure all atypical melanocytes are removed.
            Immunohistochemical staining was performed using Melan-A (A specific marker of Melanocytes)
            to ascertain the degree of melanocytic hyperplasia and presence of intraepidermal melanocytes.  Aprropriate postive and negative controls were 
            performed.  Melan-A primarily stained lentiginous cells along the elongated rete with occasional pagtoid cells.  These findings support the above histological diagnosis.
            [b]THIS CASE WAS REVIEWED AT THE DAILY INTRADEPARTMENTAL CONFERENCE…..[/b]
             
             
            So the Derm says the prior damage (nair chemical burn and ruptured the mole pretty good andTook a few months to heal) definitely could have played into the architectural and cytologic atypia but the problem is, it doesnt matter.  Can't be proved but not ruled out. Understandably when a cell is atypical it's atypical, it doesn't matter how it got that way.  It could have been a normal mole, could have been a mildly atypical mole etc.  Regardless iIt's severe and needs to come out.
            • January 15, 2016 at 2:51 am
            Rlukas79
            Participant

              Pathology report reads:

              Junctional melanocytic nevus with elongated. fused rete ridges and concentric lamellar fibrosis within the underlying papillary dermis.
              A mild superficial dermal lymphocytic infiltrate is identified.  Cytologic atypia is severe.
               
              The whole path report reads:
              The lesion appears to be completely excised, but is close 
              to a lateral (peripheral) inked edge.  Conservative
              re-excision is recommended to ensure all atypical melanocytes are removed.
              Immunohistochemical staining was performed using Melan-A (A specific marker of Melanocytes)
              to ascertain the degree of melanocytic hyperplasia and presence of intraepidermal melanocytes.  Aprropriate postive and negative controls were 
              performed.  Melan-A primarily stained lentiginous cells along the elongated rete with occasional pagtoid cells.  These findings support the above histological diagnosis.
              [b]THIS CASE WAS REVIEWED AT THE DAILY INTRADEPARTMENTAL CONFERENCE…..[/b]
               
               
              So the Derm says the prior damage (nair chemical burn and ruptured the mole pretty good andTook a few months to heal) definitely could have played into the architectural and cytologic atypia but the problem is, it doesnt matter.  Can't be proved but not ruled out. Understandably when a cell is atypical it's atypical, it doesn't matter how it got that way.  It could have been a normal mole, could have been a mildly atypical mole etc.  Regardless iIt's severe and needs to come out.
              • January 15, 2016 at 3:22 am
              Janner
              Participant

                Family docs misdiagnose melanoma 73% of the time.  Do you trust their opinion or a derm who specializes in skin's opinion?  Get your margins and stay with yearly visits.  You know the reason this mole was more atypical than the others was because of trauma.  Just do your monthly self exams.  Take pictures of your other moles if it makes you feel better.  If you see an ugly duckling or something that is seriously changing, you can always call for an appointment,  I've had three primaries and I absolutely do NOT rely on my derm or anyone else to find melanoma.  I have spotted all mine and expect to if I have more in the future.  Seeing a derm more often doesn't really accomplish that much.  Monitor your moles for change using pictures.  If you document change, that is a reason for a biopsy  — not some doc taking a five second glance who is supposed to remember what your moles looked like from your last visit.  I biopsy nothing that isn't changing.

                Most paths over diagnose, not under.  Severely atypical is not melanoma and may never become melanoma. It's just a higher risk lesion.  Relax!

                  • January 15, 2016 at 3:49 am
                  Rlukas79
                  Participant

                    Thank you for the reply.  The Internet is such a hard place to find the right information. Apparently doctors as well. You are right about listening to the derms advice for once a year visits. They did encourage me to look into mole mapping and I did reach out to the university of penns pigmented lesion group and they said they would take me on just due to history.  That happens April 1st. I'll be vigilant too.  I have baseline photos to compare monthly. I just wish my wife would take me seriously when I ask her to help. She's the it's not a problem until it's a problem type and I'm the opposite. I'd rather be proactive.  I'm that way with anything

                     

                    thank you Janner. We may not know each other but you have no idea how much you made me relax.

                    now I gotta figure out how to get a three year old girl to sleep. 

                    • January 15, 2016 at 3:49 am
                    Rlukas79
                    Participant

                      Thank you for the reply.  The Internet is such a hard place to find the right information. Apparently doctors as well. You are right about listening to the derms advice for once a year visits. They did encourage me to look into mole mapping and I did reach out to the university of penns pigmented lesion group and they said they would take me on just due to history.  That happens April 1st. I'll be vigilant too.  I have baseline photos to compare monthly. I just wish my wife would take me seriously when I ask her to help. She's the it's not a problem until it's a problem type and I'm the opposite. I'd rather be proactive.  I'm that way with anything

                       

                      thank you Janner. We may not know each other but you have no idea how much you made me relax.

                      now I gotta figure out how to get a three year old girl to sleep. 

                      • January 15, 2016 at 3:49 am
                      Rlukas79
                      Participant

                        Thank you for the reply.  The Internet is such a hard place to find the right information. Apparently doctors as well. You are right about listening to the derms advice for once a year visits. They did encourage me to look into mole mapping and I did reach out to the university of penns pigmented lesion group and they said they would take me on just due to history.  That happens April 1st. I'll be vigilant too.  I have baseline photos to compare monthly. I just wish my wife would take me seriously when I ask her to help. She's the it's not a problem until it's a problem type and I'm the opposite. I'd rather be proactive.  I'm that way with anything

                         

                        thank you Janner. We may not know each other but you have no idea how much you made me relax.

                        now I gotta figure out how to get a three year old girl to sleep. 

                      • January 15, 2016 at 3:22 am
                      Janner
                      Participant

                        Family docs misdiagnose melanoma 73% of the time.  Do you trust their opinion or a derm who specializes in skin's opinion?  Get your margins and stay with yearly visits.  You know the reason this mole was more atypical than the others was because of trauma.  Just do your monthly self exams.  Take pictures of your other moles if it makes you feel better.  If you see an ugly duckling or something that is seriously changing, you can always call for an appointment,  I've had three primaries and I absolutely do NOT rely on my derm or anyone else to find melanoma.  I have spotted all mine and expect to if I have more in the future.  Seeing a derm more often doesn't really accomplish that much.  Monitor your moles for change using pictures.  If you document change, that is a reason for a biopsy  — not some doc taking a five second glance who is supposed to remember what your moles looked like from your last visit.  I biopsy nothing that isn't changing.

                        Most paths over diagnose, not under.  Severely atypical is not melanoma and may never become melanoma. It's just a higher risk lesion.  Relax!

                        • January 15, 2016 at 3:22 am
                        Janner
                        Participant

                          Family docs misdiagnose melanoma 73% of the time.  Do you trust their opinion or a derm who specializes in skin's opinion?  Get your margins and stay with yearly visits.  You know the reason this mole was more atypical than the others was because of trauma.  Just do your monthly self exams.  Take pictures of your other moles if it makes you feel better.  If you see an ugly duckling or something that is seriously changing, you can always call for an appointment,  I've had three primaries and I absolutely do NOT rely on my derm or anyone else to find melanoma.  I have spotted all mine and expect to if I have more in the future.  Seeing a derm more often doesn't really accomplish that much.  Monitor your moles for change using pictures.  If you document change, that is a reason for a biopsy  — not some doc taking a five second glance who is supposed to remember what your moles looked like from your last visit.  I biopsy nothing that isn't changing.

                          Most paths over diagnose, not under.  Severely atypical is not melanoma and may never become melanoma. It's just a higher risk lesion.  Relax!

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