markmsn

Wait until you get the pathology report. By them calling back saying “Melanoma” could mean different things. If its a “Melanoma in Situ” or “severely atypical but lets call it Melanoma” Means the same thing and is just on the top surface. You get extra skin removed and will likely never deal with it again (cured for life). Even thin Melanoma’s and slightly deeper invasive MM can be cured by the procedure. Wait and see what the path reports say – ulceration and mitosis are important aspects.

I was in your same situation about 8 months ago with my biopsy. They told me it was a benign atypical proliferation but the doctor that did the excision called it “melanoma in situ” The pathology states that “most consistent with an early/evolving melanoma in situ” Which you should know is NOT REPORTABLE to SEER cancer registry. So if truly severely atypical or evolving they should code it as ICD10 D48.x Which is benign and not needing to call it “cancer”

For cases diagnosed 2018 and later, early or evolving melanoma is not reportable.

Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. The tumors may be described as “proliferation of atypical melanocytes confined to epidermal and adnexal epithelium,” “atypical intraepidermal melanocytic proliferation, “atypical intraepidermal melanocytic hyperplasia”; or “severe melanocytic dysplasia.” Not reportable.

Melanoma Solid Tumor Rules, 2018, page 3, https://seer.cancer.gov/tools/solidtumor/Melanoma_STM.pdf

I had almost the same thing done 5 weeks ago but just in front of my tragus (they actually did the WLE into it though) .   Now you can barely tell I even had the surgery.  I recommend a MOHs surgeon as they know how to make the incision lines hidden right along your ear.   Mine was MIS as well (or at least atypical) . I've had conflicting information.   They did the 5mm margins on mine.    

They usually grow for up to three weeks then stop. Are you sure this mole/lesion wasn’t already existing and just missed?

I’m thinking Atypica/In Situ as well. Nodular melanoma grows fast (from nothing to something in a week or two) If its been there for a year or longer I do not believe this is something to worry about. Let us know what you find out!

It is typical for two to look at it (especially when not a clear case) There are so many people with atypical lesions and just never know it. Being your own advocate is what is best. There is a borderline which many diagnosis fall between. Its in the best interest of the pathologist and/or surgeon to treat it as “if it were” melanoma in those cases. It covers you against a possibility it could become invasive (or more so) and them for lawsuits. As mentioned above – if you have a patient portal you can usually get access to the pathology report. Caution though not to read too much into it and let others help you interpret the results.

I had a small dark spot removed over a year ago. It was like 1 or 2mm in width. The Derm told me it was benign but they wanted to take more out. The MOHs surgeon said it was Melanoma in Situ – but so he could treat it as such. The practice manager then told me he would just call it a “neoplasm of uncertain behaviour” as it was somewhere between a MIS and Atypical but nobody could decide. It was better to err on that side of caution and take the larger margin and never deal with it again.

Bubbles- you are fantastic! Those were great reads! It does not appear causal as many of the studies failed to show any association. Except for 250 to 500 tablets where there may be a slight increase but could still be detection bias.

Hi Bubbles – I appreciate those links since I am worried about being on Silendafil. I do have a question though– do you have any other studies showing this non-association? Those are all from the same Stacy Loeb MD which I’m on the cautious side since she’s a paid consultant for Eli Lilly (The company that makes Cialis which is also a PDE5 inhibitor.) Trying to make sure this isn’t some kind of a cover-up from somebody close to the source. Thank you!! Below you will find her credentials so I am skeptical of this study refuting it without seeing others.

Stacy Loeb
Honoraria: MDxHealth, Boehringer Ingelheim, Astellas Pharma

Consulting or Advisory Role: Bayer, GenomeDx, Eli Lilly

Expert Testimony: Eli Lilly

Travel, Accommodations, Expenses: Sanofi, Minomic

Sorry one of the links was broken:

https://www.jaad.org/article/S0190-9622(18)31117-4/fulltext/

I couldn’t find too much on the Dr. Stacy Loeb (the person that refuted the link) but she is cited as a paid consultant for the company that makes Cialis. Sorry- I just wanted some honest opinions of PDE5 inhibitors (Viagra…etc) before I take that road.

https://books.google.com/books?id=3d49DwAAQBAJ&pg=PR3&lpg=PR3&dq=eli+lilly+consultant+Stacy+Loeb&source=bl&ots=G7560P5waL&sig=ACfU3U0dcXj-w8z7WKu1njdtx60UEGF0Cg&hl=en&sa=X&ved=2ahUKEwiHvNL29IjkAhUROK0KHWVIBrMQ6AEwCnoECAkQAQ#v=onepage&q=eli%20lilly%20consultant%20Stacy%20Loeb&f=false

Lawsuits and mayhem aside– do any of you think there is a plausible link? I asked only because I was diagnosed with an early melanoma and wanted to try Sildenafil but got scared after I read some of the research. I hate that these stupid class-action lawsuits came in when all I wanted to know was the truth in this medication. I read somewhere that the person that refuted the link was a Dr. Loeb who was actually a paid rep for the company that makes Cialis. So on with a couple of other studies that I had in question.

Newer studies include one not on Viagra but on Sildenafil use for Pulmonary Hypertension (you have to use a PC to see the study details)

2018 study: https://www.jaad.org/article/S0190-9622(18)31117-4/fulltext – This article shows an OR of 2.98, 95% CI or a 298% increase over controls. Could this be valid?

2018 Study: https://www.ncbi.nlm.nih.gov/pubmed/29884444 – shows just a slight increase over controls but still an increase

2017 Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644484/ – 2016 article telling how PDE5 inhibitors release the brakes on Melanoma growth.

Those being said– what do you think? Is it safe or should I wait to hear of other studies before taking something that is (no turning back) The only thing that really worried me was the last study and it explains pretty clearly how “pathway is hyperactivated in the majority of melanomas, typically through somatic gain-of-function mutations of the BRAF gene”

The studies seem pretty plausible. I just wanted to know the general consensus from real experts from the MRF. These money-maker lawyers need to step aside until ALL evidence is proven.

However that involves the dermis and not the epidermis (Where Melanoma in Situ lives) .   

In this article it states how rare metastasis is in Melanoma in Situ stating only a few cases have ever been reported.   Out of the three listed – two had evident regression.

https://www.sciencedirect.com/science/article/pii/S2352587817300104