BillMFl

In general the depth of the lesion is more critical than the diameter. But usually the larger the diameter the greater the likelihood it has penetrated beneath the top layer of skin and into where it can more easily spread. I could throw more technical lingo at you, but that should come from his doctor. ALM is less common but not all that rare. Surgery to remove the lesion is just the first step. This is just the beginning of his melanoma journey. If he agrees you may want to go to his appointments and participate in his care. And emotional support will be important in his journey!

I was active here for many years. Had the privilege of meeting many fellow patients in person especially at get together that were sponsored by the MRF back in the old days. Years ago I was volunteer of the year at Moffit Cancer Center and organized patient support group get together. I hope this board is able to rebuild to the level it used to be. Information can save lives!

Hey I had my first mm dx like yours over 20 years ago. A second a little deeper 10 years ago. Good for you to catch it early and have it removed! Just do self exams and keep your appointments with your derm on a regular basis. Your odds for complete recovery on this one are virtually 100%. And now that you know what to look for you should be good to go! Get them early= no worry. I see my derm every 6 months. Regular monitoring is the key.

Good luck with your decision! I am very conservative and prefer a needle biopsy as a first step. Not a pleasant experience but can eliminate “false” positives. Many others are more comfortable using the heaviest “hammer” from the getgo. It is more likely for distant Mets to first appear in a sentinel node but truth be told mm has the ability to take a variety of paths and is not totally predictable regardless of where it occurs or where it travels to. The main thing is to make the decision you are most comfortable and then be very proactive with monitoring your all your results, staying informed and keeping all followup appointments, etc. Be proactive, get full explanations from your care givers, and fully embrace a healthy lifestyle! Eat well, report any unusual symptoms, etc., get plenty of exercise (exercise can help control stress). Be your own advocate and don’t be shy about asking questions! Treatment options have come a long way since my initial dx (there was surgery and very toxic chemo and not much else). Knowledge is power and every patient deserves full explanation of their situation and probability of outcome. Never be shy about asking questions from your care givers! There are many long term survivors regardless of stage at time of dx. A positive attitude and healthy life style are very important!

I hate this whole situation for you. Your Derm said said you had a severely dysplastic lession but did not define what type? If it truely a melanoma the report should have stated so. Dysplastic is not benign. That term is often used to describe a lesion that has substantially abnormal cells that are not yet a clear stage of melanoma, basil cell or squamous cell cancer. A severely dysplastic lesion should be removed promptly. I am guessing that she took a second look at your path report and thought it would be best to get it out promptly. This is a resonable decision that is in your best interest. I am sure the path report described detail about the size, type and general appearance of the cells and their nuculie. Based on the limited info you have shared I think it would be wise to go back to her ASP but not to worry about being at great risk. Most Derms I know will freely give me a copy of my dx path report. It is your right as a patient under the freedom of information act. Ask for a copy when you back in and lots of us can help you understand the terminology.

Wow! I remember you when you first came on board. What a journey you have been on! This board has always benefited from folks like you who have learned so much on their journey and take the time to share. So much has changed since I was a regular here. So many more treatment options! Back in the day there was surgery, Interferon and poison cocktails of chemo and not much else. I am an advocate of diet and exercise for improving overall health, but not as a cure. I am so pleased to hear how advanced mm patients are seeing results that just were not available a few years ago. Thank you for being such a strong advocate for others in need of information and hope.

Wish you could have asked the teacher if she was stupid or just insensitive. Her question was sooo out of line. My best friend recentlyt found out he has ALS. I took him to lunch as usual and let him say as much or as little as he wished. He chose to be very open and we had a frank and warm discussion. I will always be driving now because he can't. We talked about the odds but also how they vary widely between individuals much like melanoma. We both know his illness is usually a death sentence as there are no effective treatments. But he is my friend and will be regardless. And I am there to listen not question.  

There is an excellent brand of stylish protective clothing from SOLUMBRA. It is specifically designed for active outdoor folks. Not cheap but very good quality. I have used their clothing for boating, beaching, etc. I belive they provide an SPF of 100. Having had two mms and dozens of basal and squamous skin cancers I mostly limit my outdoor activities to morning and evening. I confess to not liking to smear  on sunscreen goop and only use it if out during peak sun hours. Google Solumbra and ask for their free catalog. And no, I don't get paid for suggesting them. There are other active sportswear lines but I personally think they are one of the best.

MM of the nail usually begins where the nail first begins and gradually extends outward as the nail grows out. It typically looks like dark streak extending from the nail bed as opposed to a bruise under the nail which tends to travel out as a spot rather than a streak. No streak usually no melanoma. Chances are you have nothing to worry about unless you have seen something like I described. If you want total peace of mind ditch the polish etc before your appointment.

Good for you Nichole! I lean towards being proactive vs wait and see. Good luck and post any future results etc.

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!

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. 🙂

Too late for this one but in the future you might request an exscisional biopsy next time. Some docs will refuse others will say yes. For me, after my first dx based on a modified (slightly deeper shave biopsy) I subsequently insisted on an exscisional biopsy on my second mm years later. The goal is to remove the entire lesion on the initial biopsy rather than leaving a part of it behind. The docs often prefer to remove a minimal amount unless the lesion is blatantly obvious. My personal opinion is if in doubt take it all out. Especially when you have a prior positive. Some will, some won’t but a strong request often gets results.