Forum Replies Created
- January 17, 2019 at 10:00 pm
There are two types of keratosis that come to mind, you description needs more clarification.
Seborrheic keratosis. Often times weird looking even to the point they can look like melanoma. They can look ugly, but they typically have a "top" on them that is quite identifiable. Freezing isn't always the best option because SKs can come back even after freezing. I personally would not have one of these frozen especially if it was on my back – is it that cosmetically problematic that you can't live with it? Instead, I would either demand a biopsy or take pictures and monitor it for change. Freezing it destroys it but doesn't answer any questions and it may just come back. SKs are totally benign and often show up as people age. I have quite a few and I know what they are and are just living with them.
The other type of keratosis often seen in those with melanoma is actinic keratosis. These are precursors for squamous cell carcinoma. They are often rough patches, scaly, or sores. These can be frozen and destroyed or biopsied. Freezing or topical chemo cream can usually take care of these before they become something worse..
- January 17, 2019 at 4:42 pm
It's difficult to even comment without seeing the actual report. If you want it totally excised, then I see no issue waiting until April to have that done then. At least from the part you posted – no significant atypia – I wouldn't be stressing this in the least. Even if something were to change, these things are typically very slow growing. If having the excision done will make your mind more at ease, then have it. But I wouldn't stress the time frame given the tiny bit of info you gave us. For many mildly atypical moles with close margins, they will tell you to just monitor the scar area and if there is any regrowth, remove it then. That is also a valid followup plan. But if you want it gone, have it done in April.
- January 17, 2019 at 4:34 pm
You're reading into this too much. If you don't have some type of architectural or cellular changing (including hyperplasia), then you don't have an atypical lesion – you have a totally normal mole. Reading your diagnosis line by line is NOT helpful. The description portion is what is justifying the final diagnosis. You do NOT know more than the pathologist who read the slides and if s/he thought it was an in situ lesion, then that would have been the final diagnosis. If you don't trust the pathologist, then get a second opinion. But don't try to read between the lines of a pathology report and think you can interpret it differently. It doesn't work like that and you are spinning your anxiety wheels for nothing.
- January 13, 2019 at 4:39 pm
Basically, having the wide local excision and the SLNB is standard of care for everyone with a stage 2a melanoma. I'm confused about your one statement. The SLNB is designed to identify at least one lymph node – that's the purpose. You want to see if the first lymph node in the chain has any melanoma. So you will want to have at least one lymph node removed otherwise the procedure failed Are you meaning to say if there is melanoma in that lymph node they will remove the rest of the lymph nodes? If so, research CLND (complete lymph node dissection). Standards have changed regarding that procedure in recent years.
As for time off work, that is totally dependent upon location and individual and how extensive the surgery was. Some need more, some need less.
- January 13, 2019 at 4:48 am
A cyst is just a fluid filled sac. This sounds like it is more blood filled. This doesn't sound like nodular melanoma, it sounds like "a fluid filled sac". First rapid growth then deflation, a cyst sounds much more likely. Nodular melanoma is going to be a solid tumor. Yes, the top can bleed but that is usually not an immediate symptom, it tends to be on lesions that have had a longer time to grow. Go with the most likely explanation first and that wouldn't be nodular melanoma (which is actually quite rare relatively speaking).
- January 13, 2019 at 4:42 am
It could easily be a freckle. I have freckles that have shown up in my WLE scars. However, they are in areas where I already have a lot of freckles. We didn't even biopsy mine (and this was over a decade ago). If you cut thru a freckle, it's not uncommon for it to grow back thru scar tissue. As for what to do about yours, it's totally up to you and your comfort zone. I probably would take my time and take a couple of photographs and watch it for a month or so. But I'm not an alarmist. YOU have to do what makes YOU comfortable. And if that is going to the derm now, then that's what you do. Good luck!
- January 8, 2019 at 4:19 pm
Typically we recommend than the entire lesion be removed when biopsied. But given this was on your face, I understand the rationale of doing a partial biopsy. In general, you'd expect the deepest portion to be located in the most concerning area. But there is no way to know that for certain. So we can't speculate on the WLE and any possible upstaging when the majority of the lesion wasn't removed.
The scientific description is of little value to piece word by word. It basically justifies the diagnosis. The important part is melanoma in situ. In the melanoma world, that's what you want to see. As for the scar, it depends on a lot of things. Location, tightniess, basic anatomy. The face covers a lot of area. In general, to get 5mm margins, you start at the biopsy site and scribe a 1cm circle – 5mm all around the center lesion. But then on two sides, you lengthen the area to make an ellipse. The length needed is generally 3 times the width so you can close a wound without a pucker. That's a basic guideline because it all depends on where the lesion is located, skin movement, tightness, things like that. Is the surgeon a plastic surgeon? Someone who does a lot of facial reconstruction? I'd just make sure the surgeon is well qualified and hopefully everything will go just fine with no deeper component and scaring minimal.
- January 7, 2019 at 7:30 pm
No one can tell from a picture. It is unusual, but unusual isn't necessarily bad. However, unusual does say that you should visit a dermatologist to have it evaluated. I wouldn't stress about it, but I would have it looked at by a professional. It's not anything bad unless a pathology report says it is bad!
In the US, you would not have a SLNB either. The cutoff is usually 0.8mm or stage 1b. You’ve already had more testing than you’d get here. Scans of any type (except possibly a baseline chest xray) are not done for stage 1a. PET scans only identify tumors of a certain size, about 5mm. Since it’s extremely unlikely for someone with your depth to have spread with a large tumor, scans are not really helpful. In fact, scanning early stages often causes more issues because they see some benign barnacle (which are all have) but have to rule out metastasis. So more testing or surgery to show you have no mets.
- January 7, 2019 at 5:53 am
Your staging is consistent with most early stagers, you don’t know N and M because statistically the odds are small that they would be positive. My first melanoma was .58mm, 1 mitosis. That was in 1992. I’m still stage 1 all these many years later even though I’ve had 3 primaries.
As for diet, there is no diet proven to prevent metastasis. Healthy eating is always encouraged so eating healthy is always a good idea. But even the healthiest eaters still get cancer.
- January 18, 2019 at 4:26 pm
First off, my name isn't Janet. 2nd, the original poster said he has read tons of my replies before. I've been on this site for 17 years and probably have 1000s of posts many regarding pathology and early stages. He certainly knows my style if that's the case. I'm sorry you didn't like my reply but the OP is obsessing about a pathology report for something not melanoma and questioning the accuracy of the report. None of us are pathologists – if he wants a second opinion, he should get it and I stated that.. But I stand by what I said and how I said it. He has indicated he has an ability to overthink and this lesion isn't worth overthinking. I'm sorry you were offended by my post. If others think the same, I can easily move on.
- January 17, 2019 at 7:40 pm
NO! Let it go. Melanocytic hyperplasia is the reason this is moderately atypical. You should put this report away and never look at it again because it isn't worth any stress. I'm not going to answer any more questions on this report and you shouldn't spend time worrying about it.
- January 17, 2019 at 5:10 pm
Your skin is swollen from trauma – that's epidermal hyperplasia. Melanocytic hyperplasia is enlarging of the melanocytes due to some type of atypical process. There is nothing about the report that is troubling in the least. Get it excised if you want but don't stress about it or the delay.
- January 14, 2019 at 4:56 pm
Yes, but that isn't the goal of the whole procedure. You WANT the tracer to go to the 1st lymph node – the sentinel node. Sometimes it goes to more than one node. The tracer shows the drainage pathway from the original tumor to the first lymph node and it is only rarely that it doesn't go anywhere. Typically those cases have had a lot of surgery at the original site prior to the SLNB and the drainage path has been disturbed. You want the tracer to go to the nearest lymph node(s) so you can check for traces of melanoma. Does the surgeon do a lot of SLNB? Because that's a question I would be asking.
- January 13, 2019 at 4:30 pm
Just as a side note, lentiga maligna has the highest local recurrence rate of any type of melanoma. I've seen it written between 20 and 50% may have a local recurrence (depending upon which paper you read). Most times it recurs as Lentigo Maligna, but occasionally it will recur as Lentigo Maligna Melanoma. (It's call Lentgo Maligna if it's in situ, Lentigo Maligna Melanoma if it's invasive). Most melanomas are superficial spreading, but if the original poster had lentigo maligna melanoma, then a doc visit is warranted.
- January 7, 2019 at 5:37 pm
I mean – they see something on a scan – and while it doesn't look bad, it might not be completely normal. So then they have to do repeat scans or even surgery to RULE OUT MELANOMA. The same scan without a melanoma history would not prompt them to do anything. At least in the US which doesn't have a socialized medicine system, docs will often do more because 1- they make money and 2- they have less legal liability if they check everything. "More" isn't always better.
For someone with your stats, the wide excision is the end of treatment in the US. You would just be followed up with periodic skin checks. I always recommend taking pictures of your lesions to watch for change. And take pictures of all your skin to watch for new lesions. 75% of melanomas arise on new lesions. While the vast majority of warriors never have a second melanoma primary, your risk of getting one is higher than your risk of a recurrence. Personal vigilance is good!