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Primary …

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    • July 11, 2017 at 6:03 pm
    Jeff_in_FL
    Participant

      Hi all,

      Sorry if this question sounds stupid, but wondering how a "Primary" lesion is determined. Mine was Nodular, and it came out of nowhere …was not an existing mole. I haven't felt well in months, and actually lost over 20 pounds since this past December. I actually had to request a PET scan (scheduled for 7/21) as my Derm didn't think it was necessary …even after telling her that I have been having night sweats. All I asked of her was her assurance that the lesion that was removed was the primary one. She couldn't answer that. Gee, why is ordering a PET scan such a difficult thing to do? At least it could provide some peace of mind when there are unanswered questions.

      Was I out of line asking for this? Should a patient go on blind faith? I had my first "three-month" checkup, and was out of there within about 10 minutes. She just did a quick go-over and sent me on my way. Wondering how a physician can detect changes with nothing to compare to …photos?

      I find this whole thing quite frustrating.

      (((Hugs))) to everyone!

      -Jeff

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        • July 11, 2017 at 6:40 pm
        jennunicorn
        Participant

          A primary for melanoma is a tumor of the skin. Half come from existing moles and half come from new moles. Mine was also a new out of nowhere mole. If you had internal tumors elsewhere, those would be metastasis spread from the primary tumor on the skin, which is the nodular mole that was removed. Some people have unknown primaries, where an internal tumor is found and is tested to be melanoma, but the primary mole of the skin was never found. Sounds like you might want a different dermatologist if this one is not meeting your needs. Sometimes we have to do a little shopping around until we find the right fit. 

            • July 11, 2017 at 6:59 pm
            Jeff_in_FL
            Participant

              Thanks, Jenn. I learned something that I didn't know. Not sure why my Dermatologist didn't tell me any of this! I will be seeing someone else for my next checkup, not really by choice, but because we are moving to a different part of the state. I am in the VA Healthcare system, so I won't have a choice on who I see …just someone who works out of that particular area.

              Thanks again.

              • July 11, 2017 at 7:38 pm
              Janner
              Participant

                Did your "primary" have a depth?  Because your pathology report would tell you whether or not this is a primary lesion or considered a metastatic lesion.  If the report has a depth, that means it is considered a primary lesion.  It is measuring growth from the epidermal junction to how far it has invaded the tissue.  Melanoma primaries grow from the "top down".  Metastatic lesions, on the other hand, travel through the lymph or blood vessels which are located in deeper tissue in the skin.  So metastatic lesions tend to grow from the "bottom up".  This is not an unbreakable rule and there are some lesions that are not cut and dried in the diagnosis.  But the pathology report would indicate that the lesion may be metastatic. 

                My father was in the VA system for his melanoma and, all in all, had great care.  He was offered all the same options as he would have had with private insurance.  And he also saw melanoma experts who spent time at the VA.  I hope your experience is as good. 

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