› Forums › General Melanoma Community › Waiting for Biopsy
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5dives.
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- June 7, 2014 at 5:54 pm
Hello all,
I had a lesion removed from my leg several days ago that I feared might be a melanoma (new lesion, irregular borders, very dark) and am awaiting biopsy results. My dermatologist, who normally quickly dismisses lesions with a "that's fine" or "that's an AK" this time said "it might not be a melanoma" and "let's hope it's not".
In my mind, I will be very relieved if the biopsy is negative, but I guess I'm pessimistic based on his words.
I'm not one to take things lying down (like the rest of you!) and I'm looking ahead to what will be my next step. If the diagnosis is melanoma, I know I will need an excision and possible node biopsy. My questions for the group are:
1. Is the excision generally handled by the same dermatologist who did the biopsy, or should I be researching melanoma specialists (Chicago area)?
2. When is it appropriate to get a second opinion? After biopsy results? After staging?
I am not worrying about a diagnosis that hasn't come yet, but my cousin died of melanoma and I don't want to waste time.
Any suggestions appreciated.
Thank you,
Elaine
- Replies
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- June 7, 2014 at 11:48 pm
You're jumping the gun here. It could just be an atypical lesion. It could be a sebhorreic keratosis. Those questions are best answered AFTER you have a diagnosis. I know it feels good to have a plan, but it's more important to have a diagnosis and NOT speculate. Deal with the facts, and then you can make the right decision! We're here to help then, but there is just too much unknown to give you good advice at this time.
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- June 7, 2014 at 11:48 pm
You're jumping the gun here. It could just be an atypical lesion. It could be a sebhorreic keratosis. Those questions are best answered AFTER you have a diagnosis. I know it feels good to have a plan, but it's more important to have a diagnosis and NOT speculate. Deal with the facts, and then you can make the right decision! We're here to help then, but there is just too much unknown to give you good advice at this time.
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- June 7, 2014 at 11:48 pm
You're jumping the gun here. It could just be an atypical lesion. It could be a sebhorreic keratosis. Those questions are best answered AFTER you have a diagnosis. I know it feels good to have a plan, but it's more important to have a diagnosis and NOT speculate. Deal with the facts, and then you can make the right decision! We're here to help then, but there is just too much unknown to give you good advice at this time.
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- June 8, 2014 at 7:36 pm
Elaine,
While I agree with Janner that you are jumping the gun and need to wait for the biopsy results, there are other answers to your questons that can be given now.
1. If your lesion is big (which I unfortunately can't define for you!) or in a difficult place, the wide excision may need to be done by a plastic surgeon, not by the dermatologist who removed the lesion. If they decide to do a sentinel node biopsy, that will likely be done by a cancer surgeon. In most cases that I've heard of, they work together as a team so that you only have one surgery.
2. Whether you need a second opinion also depends in part on the size of the lesion – and also on what diagnosis is given, and by whom. Even if the pathology report is prepared by a dermatopathologist who sees a lot of melanoma, if you end up consulting with a melanoma specialist, s/he may want to have a dermatopathologist s/he knows and works with a lot review the slides.
If your case is clear-cut and the lesion is small – if you are told it's melanoma in situ or Stage 1 – you might not need a melanoma specialist involved. The time for a second opinion is when there are uncertainties – if you have melanoma of unknown primary (which won't likely be your situation, since you had a lesion removed) or other unusual circumstances.
Hard as it is to wait, that's all you can do right now. Don't worry about wasting time – and don't waste time worrying!
Hoping the best for you —
Hazel
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- June 8, 2014 at 7:36 pm
Elaine,
While I agree with Janner that you are jumping the gun and need to wait for the biopsy results, there are other answers to your questons that can be given now.
1. If your lesion is big (which I unfortunately can't define for you!) or in a difficult place, the wide excision may need to be done by a plastic surgeon, not by the dermatologist who removed the lesion. If they decide to do a sentinel node biopsy, that will likely be done by a cancer surgeon. In most cases that I've heard of, they work together as a team so that you only have one surgery.
2. Whether you need a second opinion also depends in part on the size of the lesion – and also on what diagnosis is given, and by whom. Even if the pathology report is prepared by a dermatopathologist who sees a lot of melanoma, if you end up consulting with a melanoma specialist, s/he may want to have a dermatopathologist s/he knows and works with a lot review the slides.
If your case is clear-cut and the lesion is small – if you are told it's melanoma in situ or Stage 1 – you might not need a melanoma specialist involved. The time for a second opinion is when there are uncertainties – if you have melanoma of unknown primary (which won't likely be your situation, since you had a lesion removed) or other unusual circumstances.
Hard as it is to wait, that's all you can do right now. Don't worry about wasting time – and don't waste time worrying!
Hoping the best for you —
Hazel
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- June 8, 2014 at 7:36 pm
Elaine,
While I agree with Janner that you are jumping the gun and need to wait for the biopsy results, there are other answers to your questons that can be given now.
1. If your lesion is big (which I unfortunately can't define for you!) or in a difficult place, the wide excision may need to be done by a plastic surgeon, not by the dermatologist who removed the lesion. If they decide to do a sentinel node biopsy, that will likely be done by a cancer surgeon. In most cases that I've heard of, they work together as a team so that you only have one surgery.
2. Whether you need a second opinion also depends in part on the size of the lesion – and also on what diagnosis is given, and by whom. Even if the pathology report is prepared by a dermatopathologist who sees a lot of melanoma, if you end up consulting with a melanoma specialist, s/he may want to have a dermatopathologist s/he knows and works with a lot review the slides.
If your case is clear-cut and the lesion is small – if you are told it's melanoma in situ or Stage 1 – you might not need a melanoma specialist involved. The time for a second opinion is when there are uncertainties – if you have melanoma of unknown primary (which won't likely be your situation, since you had a lesion removed) or other unusual circumstances.
Hard as it is to wait, that's all you can do right now. Don't worry about wasting time – and don't waste time worrying!
Hoping the best for you —
Hazel
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- June 9, 2014 at 4:23 am
It is approprciate to to get a second opinion any time you fell one would help you feel more comfortable with a diagnosis. If a PRIMARY melanoma is ulcerated, has mitosis. and or is deeper than 1 mm one might be concerned that the SLN is located before a WLE is done. Some Derm's don't do this, I you feel a SLN check is necessaary then make sure you see someone that will find it before the WLE. Some people have had their Derm refuse to give a (probable) Stage before doing an SLN excission. Hopefully, this is just a scary looking item and not the bad thing. Best to know for sure as early as possible either way.
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- June 9, 2014 at 11:34 pm
Janner, Hazel, and Jerry,
Thank you for your calming responses. I agree, I may be jumping the gun. I have sort of an unfortunate tendency to say "okay" to doctors, and if this biopsy comes back positive for melanoma, I don't want to give an unprepared "okay" to the doctors, if you know what I mean.
My biopsy results haven't come back yet, and in the past they've always come back quickly. I'm trying not to let that get to me. I've had numerous AKs over the years, and several mole biopsies that have always come back negative. I don't know why I feel this time may be different, but my gut tells me it is. My (very straightforward) derm did mention the possibility of a seborrheic keratosis, but quickly followed up with a "but this is quite black". I see him every year, and this spot is new, although when I saw him last summer he saw the spot (it was flat then) and said "this is okay." This year, it was no longer flat, and he seemed concerned. Wouldn't it be great if derms had biopsy eyes and we wouldn't have to agonize over biopsy results?!
What I took from your responses is that if there is any doubt about a melanoma being stage Ib or higher, I will want to have an SLN before the WLE, even if my derm thinks the WLE is fine to do before an SLN. I think that would be a pretty good sign that I might want a second opinion. I will ask for a copy of my lab report.
I'm 45, pale like a ghost, blue eyed, and I burned to the point of blistering every summer when I was a small kid, I think. My parents didn't know any better, I guess…can't be mad at them! Given that my cousin died of melanoma, I just want to be as assertive as possible.
Thank you again for your patience with my jumping of the gun. You have certainly helped me stay calmer while I wait, and I'm grateful for that.
Best,
Elaine
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- June 9, 2014 at 11:34 pm
Janner, Hazel, and Jerry,
Thank you for your calming responses. I agree, I may be jumping the gun. I have sort of an unfortunate tendency to say "okay" to doctors, and if this biopsy comes back positive for melanoma, I don't want to give an unprepared "okay" to the doctors, if you know what I mean.
My biopsy results haven't come back yet, and in the past they've always come back quickly. I'm trying not to let that get to me. I've had numerous AKs over the years, and several mole biopsies that have always come back negative. I don't know why I feel this time may be different, but my gut tells me it is. My (very straightforward) derm did mention the possibility of a seborrheic keratosis, but quickly followed up with a "but this is quite black". I see him every year, and this spot is new, although when I saw him last summer he saw the spot (it was flat then) and said "this is okay." This year, it was no longer flat, and he seemed concerned. Wouldn't it be great if derms had biopsy eyes and we wouldn't have to agonize over biopsy results?!
What I took from your responses is that if there is any doubt about a melanoma being stage Ib or higher, I will want to have an SLN before the WLE, even if my derm thinks the WLE is fine to do before an SLN. I think that would be a pretty good sign that I might want a second opinion. I will ask for a copy of my lab report.
I'm 45, pale like a ghost, blue eyed, and I burned to the point of blistering every summer when I was a small kid, I think. My parents didn't know any better, I guess…can't be mad at them! Given that my cousin died of melanoma, I just want to be as assertive as possible.
Thank you again for your patience with my jumping of the gun. You have certainly helped me stay calmer while I wait, and I'm grateful for that.
Best,
Elaine
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- June 9, 2014 at 11:34 pm
Janner, Hazel, and Jerry,
Thank you for your calming responses. I agree, I may be jumping the gun. I have sort of an unfortunate tendency to say "okay" to doctors, and if this biopsy comes back positive for melanoma, I don't want to give an unprepared "okay" to the doctors, if you know what I mean.
My biopsy results haven't come back yet, and in the past they've always come back quickly. I'm trying not to let that get to me. I've had numerous AKs over the years, and several mole biopsies that have always come back negative. I don't know why I feel this time may be different, but my gut tells me it is. My (very straightforward) derm did mention the possibility of a seborrheic keratosis, but quickly followed up with a "but this is quite black". I see him every year, and this spot is new, although when I saw him last summer he saw the spot (it was flat then) and said "this is okay." This year, it was no longer flat, and he seemed concerned. Wouldn't it be great if derms had biopsy eyes and we wouldn't have to agonize over biopsy results?!
What I took from your responses is that if there is any doubt about a melanoma being stage Ib or higher, I will want to have an SLN before the WLE, even if my derm thinks the WLE is fine to do before an SLN. I think that would be a pretty good sign that I might want a second opinion. I will ask for a copy of my lab report.
I'm 45, pale like a ghost, blue eyed, and I burned to the point of blistering every summer when I was a small kid, I think. My parents didn't know any better, I guess…can't be mad at them! Given that my cousin died of melanoma, I just want to be as assertive as possible.
Thank you again for your patience with my jumping of the gun. You have certainly helped me stay calmer while I wait, and I'm grateful for that.
Best,
Elaine
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- June 10, 2014 at 5:56 pm
Hello,
I got the call today and it is a melanoma. No staging yet, obviously, but the depth is .96mm. I've been referred to a surgical oncologist and I'm picking up my lab report later this afternoon.
Thank you for your help with my original question. I'm sure I'm about to have many more questions.
Best,
Elaine
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- June 10, 2014 at 5:56 pm
Hello,
I got the call today and it is a melanoma. No staging yet, obviously, but the depth is .96mm. I've been referred to a surgical oncologist and I'm picking up my lab report later this afternoon.
Thank you for your help with my original question. I'm sure I'm about to have many more questions.
Best,
Elaine
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- June 10, 2014 at 7:52 pm
Sorry about that.
1. Get a copy of your pathology report. Current staging is stage I. More detail we can't say without seeing the pathology report.
2. The lesion is close enough to the 1mm cutoff that having the SNB is likely to be recommended. The SNB and WLE will be done at the same surgical time. The SNB is done prior to the WLE. As long as your surgeon deals with melanoma all the time, this is a given.
3. Staging will be updated after the SNB.
Waiting is tough, but expect to wait. Wait for scheduling, wait for surgery, wait for results. Waiting doesn't affect prognosis, but it does affect your mental state! Hang in there, but realize this may take a little time.
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- June 10, 2014 at 7:52 pm
Sorry about that.
1. Get a copy of your pathology report. Current staging is stage I. More detail we can't say without seeing the pathology report.
2. The lesion is close enough to the 1mm cutoff that having the SNB is likely to be recommended. The SNB and WLE will be done at the same surgical time. The SNB is done prior to the WLE. As long as your surgeon deals with melanoma all the time, this is a given.
3. Staging will be updated after the SNB.
Waiting is tough, but expect to wait. Wait for scheduling, wait for surgery, wait for results. Waiting doesn't affect prognosis, but it does affect your mental state! Hang in there, but realize this may take a little time.
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- June 10, 2014 at 10:23 pm
Hello,
Histologic type: Superficial spreading
Breslow: .96 mm
Clark's level: 4
Ulceration: not present
Regression: not present
Mitotic Rate: 2 per mm2
Tumor Infiltrating lymphocytes: brisk
Referral to surgical oncologist for next week. Am going to try not to worry too much until then.
Best,
Elaine
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- June 10, 2014 at 10:23 pm
Hello,
Histologic type: Superficial spreading
Breslow: .96 mm
Clark's level: 4
Ulceration: not present
Regression: not present
Mitotic Rate: 2 per mm2
Tumor Infiltrating lymphocytes: brisk
Referral to surgical oncologist for next week. Am going to try not to worry too much until then.
Best,
Elaine
-
- June 10, 2014 at 10:23 pm
Hello,
Histologic type: Superficial spreading
Breslow: .96 mm
Clark's level: 4
Ulceration: not present
Regression: not present
Mitotic Rate: 2 per mm2
Tumor Infiltrating lymphocytes: brisk
Referral to surgical oncologist for next week. Am going to try not to worry too much until then.
Best,
Elaine
-
- June 10, 2014 at 7:52 pm
Sorry about that.
1. Get a copy of your pathology report. Current staging is stage I. More detail we can't say without seeing the pathology report.
2. The lesion is close enough to the 1mm cutoff that having the SNB is likely to be recommended. The SNB and WLE will be done at the same surgical time. The SNB is done prior to the WLE. As long as your surgeon deals with melanoma all the time, this is a given.
3. Staging will be updated after the SNB.
Waiting is tough, but expect to wait. Wait for scheduling, wait for surgery, wait for results. Waiting doesn't affect prognosis, but it does affect your mental state! Hang in there, but realize this may take a little time.
-
- June 10, 2014 at 5:56 pm
Hello,
I got the call today and it is a melanoma. No staging yet, obviously, but the depth is .96mm. I've been referred to a surgical oncologist and I'm picking up my lab report later this afternoon.
Thank you for your help with my original question. I'm sure I'm about to have many more questions.
Best,
Elaine
-
- June 9, 2014 at 4:23 am
It is approprciate to to get a second opinion any time you fell one would help you feel more comfortable with a diagnosis. If a PRIMARY melanoma is ulcerated, has mitosis. and or is deeper than 1 mm one might be concerned that the SLN is located before a WLE is done. Some Derm's don't do this, I you feel a SLN check is necessaary then make sure you see someone that will find it before the WLE. Some people have had their Derm refuse to give a (probable) Stage before doing an SLN excission. Hopefully, this is just a scary looking item and not the bad thing. Best to know for sure as early as possible either way.
-
- June 9, 2014 at 4:23 am
It is approprciate to to get a second opinion any time you fell one would help you feel more comfortable with a diagnosis. If a PRIMARY melanoma is ulcerated, has mitosis. and or is deeper than 1 mm one might be concerned that the SLN is located before a WLE is done. Some Derm's don't do this, I you feel a SLN check is necessaary then make sure you see someone that will find it before the WLE. Some people have had their Derm refuse to give a (probable) Stage before doing an SLN excission. Hopefully, this is just a scary looking item and not the bad thing. Best to know for sure as early as possible either way.
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