hellokitty1

I had my skin exam with my regular derm on Monday and got a second opinion today! I feel so blessed to have gotten this apt so early. He did a biopsy on the suspected birth mark and another mole that is disappearing (halo, although it's hard to see on skin as pale as mine). He did punch biopsies which my other doctor refused to ever do, and we schedualed an excisional biospy on a dark mole on my leg for next week!

I'm switching and very happy. I feel like I was finally heard and respected. Given my family history and personal history, there's a very good chance I will have melanoma one day, but I don't feel so alone anymore!

I'm sorry to hear your story, MelanomaMike.

The original dermatologist stands by his original assessment 100% and sounded very displeased in his voicemail. My new derm does excisional biopsies and I'm much more comfortable with that. No more shaves for me. From here on out, I think I'm in good hands, but goodness only knows what will come of my past removals.

I'll keep you in my thoughts, Mike.

Wow, thank you for taking the time to type that all out and explain it to me!

The second preference diagnosis. Is atypical lentigo or evolving atypical junctional nevus then melanoma? I don't know what either of those terms mean. I'm trying to figure out if "on the off chance they are wrong" means for me, are those things better or worse then the AIMP they ruled it as?

The new derm is a family friend. I hadn't been going to him up to this point because his office is an hour from my house. I do tend to trust him and he was very sure of his dagnosis.

I've had dozens of moles biopsied and 5 extracted, all but one on my head, all ruled moderate. I'm worried that some of those are AIMPs, but my old derm has never let me look at my other pathology reports and doesn't return my calls.

I just want to be ok and be sure everything was removed within standard care. I know I'm stressing, but I think that's understandable when you get somoene telling you "hey, it was cancer all along!"

My new derm says "Atypical Intraepidermal Melanocytic Proliferation" IS an insitu grading. So there's no need to say insitu on the report because that's what the term Atypical Intraepidermal Melanocytic Proliferation means.

I'm having a hard time now trusting what I'm being told. That mole was regressing. Not growing at all in size, but instead it started to look like it was molting. That's not indicated in the report at all. Now I start to wonder if it was actually a 1A melanoma and the regression was just missed. It says there was a dispute between lentigo (it sort of looked like an inkspot lentigo) and evolving junctional nevus. Well, the only way it was evolving was regressing, and I think they missed it.

I'm going to talk about having the slide rechecked. Thank you.

The kids thing turned out to be moot because it turns out I have other problems I didn't know about at the time. I got news about that hours before this new derm told me it was insitu, so lots of tough emotions in the last 24 hours! I'm definitely rooting for you, though! I don't know the limitations on adoption for health problems. My new derm said they avoid calling insitus institus so you won't get denied life insurance. That seems… odd… to me.

It is encouraging that your oncologist has no problems with the BC because now I have to stay on them for ovarian cysts.

The insitu or severe mole or whatever was removed, you're right. Thank the good Lord. But it wasn't re-extracted with 5mm margins, which would make me feel more comfortable. It was, however, removed completely in the biopsy and the extraction was just extra. I take comfort in that.

No one outside the UPENN pathology lab has looked at the slides. All decisions have been made on the pathology report alone. My new derm is requesting all my slides to have on hand, but I'm not sure if he's going to reevaluate the one in question because he sees it as a closed issue. This mole was biopsied a year ago and extracted. What could even be done now? My understanding is I have to live with the margins taken by the original surgeon.

The words focal crowding were significant to my new derm. He says that means insitu. He's a pathologist himself and was trained by his father, an instructor of dermatology at UPENN, so I do trust his judgement.

I do practice sun safety. But hats and long sleeves are uncomfortable in the summer, and it's hard to avoid being outside from 10-4 when you live in the middle of nowhere and every errand run takes hours, and, yeah, I'm going to be more vigilant now.

I'm not going to report this doctor. I think that's extreme, especially because I haven't had the chance to talk to him yet. Mistakes can happen and doctors can disagree.

My only goal in life has been to live long and happy with my husband (13 years so far!). If I can't have that, nothing else is really going to make me feel better. It's not worth it to sue.

If I were responding to me, I would probably say exactly what you did. But I do have over 100 moles, most of which fail one of the ABCDE criteria, have had a dozen biopsies in which not one has come back normal, and had a mole removed from inside my ear last month. And I have relatives who have had melanoma, including my mother in her 40s. I do think maybe I can learn to be stronger about this, though, and I thank you for giving me a bit of a reality check 🙂

I think I see what you're saying. You're saying the mole turns to melanoma, does it's whole melanoma thing in terms of spreading into the skin layers, and THEN regresses. Do I have that right?

Then I wonder if there were melanoma cells mixed in with the moderate and severe atypica in that same mole, and maybe those regressed after escaping. I really hope the lab would have caught that though. But I think it's obvious I'm pretty ignorant about pathology and what they can detect. I am trying to learn, though. I'm the kind of person who feels calmer and more secure the more they know. Regression scares me because it means I could be missing things. And its something I seem prone to. I have so many moles, most abnormal, it's very hard to keep track, and out of pure stupidity or perhaps stubborness, I didn't start doing self-skin checks and taking pictures until recently at 36. I have had moles removed from places like inside my ear. Combine all that with family history– I think melanoma is a pretty realistic fear for me.

Your post was actually very helpful to me. And I do thank you.

That's just pattently untrue. Mole regression is a symptom of melanoma. It's also suspsected to be one cause behind "melanoma without a primary" cases. Change is always a concern. Fading is change. I've seen pictures of very faded moles on stage 4 patients. I doubt very much it had changed for the better for them.

I had my severe mole (actually a lentigo) for 20 years before it was removed, since I was in my early teens. You're not going to convince me that it was severe the whole time. The fading was the canary in the coal mine. If I hadn't had that sucker removed, I would be in real trouble. Now, was that one different from my wrist? Yes. It was a black ugly thing from the start.

No, the thing on my wrist didn't catch my attention. Largely because until recently I was very ignorant of these matters. Also somewhere along the line I got it in my head that it was a birthmark and never gave it much thought.

It's was a rectanglish shape, about 20mm x 10mm, light yellowish tan in color and a near match for my other cafe-au-lait spot. It was flat and see-through and uniform in color. We found it in a picture of me from when I was 2 or 3 years old.

I'm not trying to be disprespectful. I know you've probably seen and know a lot more than me. But given my history, fading freaks me out. I just want answers. I don't like feeling powerless. I don't like feeling like my only option is to sit around and wait for the lump under my arm when it's already too late.

Since I can still see it in some lights, as can my husband, and there would be abnormal cells left in lower levels of the dermis were it melanoma, I still don't understand why I can't get it biopsied. I'm going to insist.

I agree with you on the oncologist and have no idea why my derm said it. He may have been joking. I know PET scans are a lot of radiation, and I wouldn't subject myself to that for a looky loo, nor do I think any doctor would perform it.

Well, that's the thing, I have no idea if the thing on my wrist was a mole or a lentigo or a cafe-au-lait birthmark. And thus I have no idea if it's concerning or not.

My severe mole was fading, not growing bigger or anything else. That's what got me to insist on its removal. So I'm scared of fading. And I'm very, very mad at myself for not noticing it on my wrist.

I'm convinced this is melanoma. And there's nothing I can do to stop it since apparently it can't be biopsied. I'm pretty depressed. My derm suggested my only option might be to go to an oncologist and have a scan.