Procedure question

Hi RDCPT28, please let me clarify, my earlier post is out of love & caringness, the “Blunt” part, in my Melanoma “Journey” over the years, iv asked questions to my Oncologists, Derm Doc, and Onco Surgeon so i know whats going on with me and each procedure being performed on me, yes, mild “hick ups” will occure along the way, especially during Pathology reading (final determination) i even had an actual Melanoma tumor come back as something else!! Forget the name they called it, Non Cancerous skin Blobersaurus will call it haha.. it was an Ulcerated type, broke through my skin (right shin) they retested (another Shave Biopsy) it grew back again in 2 months!! This time Melanoma. So, i see how Hick ups can occure with pathology & for a doc not being able to give you the real scoop in certain situations, always stay on top of it!! Ok? And when they dont make sense or fail to “Dumb It Down” a bit so we can understand, theres a lot of help here at MRF!! We have a lot of experiance plus folks will find & load up a Web Links (of accurate news) that pertains to your situation…just lookin after ya, thats all…PLEASE keepvus posted!!.

BillMFI, I want to respectfully disagree with your statement that “dysplastic is not benign”. The most recent research does not support an association between cancer and dysplastic moles. Most dysplastic moles are indeed benign and will never progress to cancer. Of course if its severe dysplasia with some worrisome histologic features then it may progress to melanoma, but until it does, it is technically still benign. I just didnt want people who had dysplastic moles to read this and freak out for no reason, because most dysplastic nevi are benign.

You should review the definition of severe dysplasia. Benign tumor cells are almost always well differentiated and resemble their normal cells of origin. Severe dysplasia usually refers to cells that are abnormal in size, shape and odd and sometimes multiple nuclei. Not yet defined as a specific type of cancer but a severe dx usually calls for removal. Mild dysplasia often requires reasonably frequent checks by a Derm. Every six months in my case because of frequent progression to malignancy. Since this patient was unsure of the dx but the Derm wanted immediate excision, it seems reasonable that the Derm has a high concern about the results. No need to nit pick about the relatively wide range of dysplasia, but if Derm is pressing for immediate removal it is likely this lesion is not benign but possibly wildly undifferentiated (anaplastic). In my experience it is unusual for a Derm to make multiple requests for a patient to come back in immediately unless there is cause for concern. In this case, for this patient, they should follow their docs advice! As to the folks with more indolent dysplasia, frequent monitoring may be all that is required. No one can make an accurate definition of this patients condition with the little info provided. But the Derms sense of urgency speaks for itself. But thank you for pointing out that there is a wide variation between mild atypia and severe dysplasia. The former may never become malignant, while the later may be in the early stage of malignancy. My personal motto has always been when in doubt, have it out (2mms, close to 40 sqs and basil cell for me). Fortunately, at 77, my skin seems to have slowed way down just like the rest of my body, haha. I don’t make any claim to technical expertise other than my own personal experience with multiple types of skin cancer, my surgery for prostate cancer, and my wifes double mastectemy for breast cancer (she is a surgical nurse who has seen just about everything over the years). Thank you for respectfully disagreeing with me. Mutual support is the primary purpose I try to focus on. There is plenty of room for debate over technical issues and should be handled gently on this board. I am after all just offering my own opinions which are only as good as my aging brain is performing on any given day. 🙂

Hi Bill, I absolutely agree with you that if in doubt, cut it out. That is why I had my moderately atypical mole removed with 5mm margins when it came back (derm didn’t recommend it but I insisted). I too absolutely agree that this patient should follow his docs advice and have it removed – the sooner, the better. I also agree that the diagnosis of dysplasia is so wide, as almost to the point of being meaningless. Most likely in this case, yes, there is enough suspicion for developing melanoma to treat it as a melanoma in situ. But in general, the “usual” dysplastic nevus (that most people have in mind when they mention dysplasia) is benign.

It is very likely that this patient has much more information in the pathology report than the doc has shared with him. As you’ve said, it is probably not a true dysplasia anymore, but rather a developing melanoma in situ caught early. Well, good for him to have caught it that early. Once it is removed with sufficient margins, he will likely never have to deal with this ever again!

Here is an old post from this forum that I have found, that I think may describe a similar situation with the path report: https://melanoma.org/legacy/find-support/patient-community/mpip-melanoma-patients-information-page/new-here-can-someone-help-me-pathology-report

In this case, it isn’t just an atypia anymore and shouldn’t be presented as such. I personally think that there should be a special term for such cases, maybe something like “developing melanoma in situ”, or “pre-malignant melanoma in situ”? Otherwise this “atypical nevus” terminology gives unnecessary worry to folks who have nothing to worry about, and unjustified comfort to those who do. This is very confusing…

Here is an article from a reputable journal to support my statement: https://www.aafp.org/afp/2015/0601/p762.html
The first sentence states that “atypical moles are benign pigmented lesions”. Atypical is the same as dysplastic.

Haha. Pathologists have lots of fancy terminology. But the reality is a lot of suspicious lesions fall into a grey area and regardless of the technical distinctions most Derms take the practical decision to play it safe rather than to wait and see. Most of us know folks who had poor outcomes because of wait and see especially years ago when there was a casual attitude of ” its only skin cancer”. As a young adult in 1960 I had zero awareness of skin cancer, what it looked like, or that sun exposure was a risk factor. 20 years later there were enough chunks removed to make a mini me. There was little or no public info out there back when I was young and “invincible”. Cheers to all the warriors out there who have it far worse than me!