› Forums › General Melanoma Community › New here: confused
- This topic has 18 replies, 6 voices, and was last updated 9 years, 8 months ago by
_Paul_.
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- December 15, 2015 at 11:06 am
Hi, everybody … please bear with me; I'm new.
To try and cut a long story as short as I can:
Age 65 (male), born and brought up in Cape Town, South Africa, and barbecued myself on the beach there on several occasions (near-cremation, more than just sunburn…), which with (then) red hair, green eyes and fair skin was clearly not the thing to do. But who thinks of these things as a teenager? You just spray on the Solarcaine after the deed, and let it go.
In 2005, at the age of 55, I had a melanoma in situ removed at Orpington Hospital in the UK. I had gone to the dermatologist about a little black spot on my lip, which I didn't like the look of. It turned out to be a harmless little thing called a venous lake, and while I was there the dermo said, 'Well, since you're this age and come from a hot country, let's just look you over while you're here.' And so the fingernail-size in-situ (it was pink rather than any of the other colours) was found on the small of my back and taken out by a consultant dermatologist who specialised in pigmented lesions. After the excisional biopsy, there was a further WLE. She said that would be the last I would hear of it.
I have had dermatological checkups (back in South Africa) every six months since then, and he has been mapping one or two odd-looking frexle-type things. Very conscientious guy.
Now, three weeks ago in Frankfurt, Germany, in the course of a dermo check-up here with an apparently amazing dermatologist who unfortunately has the personality of a roll of barbed wire and who spends three minutes with you if you're lucky, he drew caircles around four lesions, photographed them, and said: 'Those need to get taken off by a surgeon, and soon. They're very active.' On the note to the (plastic) surgeon he referred me to he had written 'highly dysplastic nevi, suggestive of Superficial Spreading Melanoma'.
Last week, the first two were excised by the plastic surgeon, and the second two yesterday. The result had come back from the lab for the first two, and she told me yesterday that there is 'no melanoma'. She said that there was nothing more to be done, barring regular checkups, of course. I'll have the result for the other two when I go to have the stitches out on 4 Jan.
My worry is, firstly, whether what has been done is enough, and whether I can acccept that there IS in fact no melanoma associated with the first two (is the lab report reliable?), and whether this has arisen from the in-situ melanoma ten years ago now? If this is so, will I have to take extra care checking? I believe it can erupt many years later than that as stage 4 in some organ without any skin problems ever occurring again.
I am aware that on this site I am in the company of many people braver and muchc better informed than I am, and to them I say sorry for this trifling query. But I have been very concerned. I'm in a country where I do not speak the language, and the dermatologist obviously wasn't in class on the day they covered 'communicating with your patients'.
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- December 15, 2015 at 1:48 pm
Hi, I think it’s a good thing they removed the suspicious spots and that 2 have already came back fine. You are your best advocate and if you feel enough time wasn’t spent on your exam then I would seek out a second opinion. Definitely perform monthly skin checks and get anything looked at that bothers you. If a mole came back as melanoma in a different spot then your first in situ then it would most often be a new primary melanoma and not recurrence. Usually if it comes back in the same spot or elsewhere inside your body then it has recurred. The good part is an in situ diagnosis has a very low chance of returning. -
- December 15, 2015 at 1:48 pm
Hi, I think it’s a good thing they removed the suspicious spots and that 2 have already came back fine. You are your best advocate and if you feel enough time wasn’t spent on your exam then I would seek out a second opinion. Definitely perform monthly skin checks and get anything looked at that bothers you. If a mole came back as melanoma in a different spot then your first in situ then it would most often be a new primary melanoma and not recurrence. Usually if it comes back in the same spot or elsewhere inside your body then it has recurred. The good part is an in situ diagnosis has a very low chance of returning. -
- December 15, 2015 at 1:48 pm
Hi, I think it’s a good thing they removed the suspicious spots and that 2 have already came back fine. You are your best advocate and if you feel enough time wasn’t spent on your exam then I would seek out a second opinion. Definitely perform monthly skin checks and get anything looked at that bothers you. If a mole came back as melanoma in a different spot then your first in situ then it would most often be a new primary melanoma and not recurrence. Usually if it comes back in the same spot or elsewhere inside your body then it has recurred. The good part is an in situ diagnosis has a very low chance of returning. -
- December 15, 2015 at 3:14 pm
Your risk of a second melanoma primary site is higher than your risk of a recurrence from the first one. If any of the new biopsies were melanoma, they would be new primaries and totally unrelated to the one you had removed before. For example, I've had three primaries and I'm still stage 1. In situ has basically close to a 100% cure rate when the surgery to remove margins is adequate. (Nothing is 100% in dermatology). Your risk of a new primary is about 10%.
If you don't trust the lab reports, ask them to send the slides to someone you do trust. In general, Germany tends to be quite progressive medically despite barbed wire personality. Ask for copies of the reports for your own files. Watch your moles for change as those tend to be the ones most likely to cause problems. Most melanoma warriors have biopsies and most of those are NOT melanoma. They can either be benign or dysplastic. Dysplastic nevi can have some odd architecture or cellular structures but are not considered cancerous themselves at the time they are analyzed, and most dysplastic nevi never turn into melanoma.
Periodic skin checks is where you should be with your previous stage 0 melanoma. If one of the biopsies comes back melanoma, get your pathology report so you can have the important info regarding the lesion.
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- December 15, 2015 at 3:14 pm
Your risk of a second melanoma primary site is higher than your risk of a recurrence from the first one. If any of the new biopsies were melanoma, they would be new primaries and totally unrelated to the one you had removed before. For example, I've had three primaries and I'm still stage 1. In situ has basically close to a 100% cure rate when the surgery to remove margins is adequate. (Nothing is 100% in dermatology). Your risk of a new primary is about 10%.
If you don't trust the lab reports, ask them to send the slides to someone you do trust. In general, Germany tends to be quite progressive medically despite barbed wire personality. Ask for copies of the reports for your own files. Watch your moles for change as those tend to be the ones most likely to cause problems. Most melanoma warriors have biopsies and most of those are NOT melanoma. They can either be benign or dysplastic. Dysplastic nevi can have some odd architecture or cellular structures but are not considered cancerous themselves at the time they are analyzed, and most dysplastic nevi never turn into melanoma.
Periodic skin checks is where you should be with your previous stage 0 melanoma. If one of the biopsies comes back melanoma, get your pathology report so you can have the important info regarding the lesion.
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- December 15, 2015 at 3:14 pm
Your risk of a second melanoma primary site is higher than your risk of a recurrence from the first one. If any of the new biopsies were melanoma, they would be new primaries and totally unrelated to the one you had removed before. For example, I've had three primaries and I'm still stage 1. In situ has basically close to a 100% cure rate when the surgery to remove margins is adequate. (Nothing is 100% in dermatology). Your risk of a new primary is about 10%.
If you don't trust the lab reports, ask them to send the slides to someone you do trust. In general, Germany tends to be quite progressive medically despite barbed wire personality. Ask for copies of the reports for your own files. Watch your moles for change as those tend to be the ones most likely to cause problems. Most melanoma warriors have biopsies and most of those are NOT melanoma. They can either be benign or dysplastic. Dysplastic nevi can have some odd architecture or cellular structures but are not considered cancerous themselves at the time they are analyzed, and most dysplastic nevi never turn into melanoma.
Periodic skin checks is where you should be with your previous stage 0 melanoma. If one of the biopsies comes back melanoma, get your pathology report so you can have the important info regarding the lesion.
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- December 24, 2015 at 10:25 am
Hi again, all … and thanks to those who responded.
Is there anyone about who is good at interpreting path results? I got my results yesterday (December 23) from the four lesions that were excised by a plastic surgeon and snet to a dermatopathology lab here inn Frankfurt, Germany.
They are in German, and I've translated them. Forgice me if the grammar is a bit wobbly, as I'm not used to medical terminology, but the facts are nevertheless still there:
- MICROSCOPY: 7 x 12 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen at the epidermal junction. Melanocytes are observed in the suprabasal layers of the epidermis as well as in the upper dermis. Heavy fibrosis and occasional concomitant inflammatory infiltration are seen.
DIAGNOSIS: Mildly dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 10 x 17 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen. Melanocytes are also seen in the suprabasal layers of the dermis as well as in the upper dermis, with concomitant variable inflammatory infiltration.
DIAGNOSIS: Active junctional melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen in the centre of the sample. Melanocytic proliferation in the suprabasal layers of the epidermis. Nested melanocytes bridging rete ridges. Occasional perivascular, lymphocytic infiltration with melanophages is seen in the dermis.
DIAGNOSIS: Mildly dysplastic melanocytic junctional naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A junctional and nested hyperplasia with enlarged melanocytes is seen. Melanocytes are seen in the suprabasal layers of the epidermis. There is melanocytic bridging of rete ridges. Fibrosis and nests of melanocytes with occasional and variable lymphocytic infiltration are seen in the dermis.
DIAGNOSIS: Dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
The surgeon actually phoned himself yesterday when he received these results, as he said he could see I was very anxious about them. He said 'Good news!'
But it doesn't look all that bright to me! Have to see the dermatologist who spotted these earlier this month (Dec) and referred me for removal. But can't get near him until mid-February, as he is going on holiday and the practice is closed.
Any insights in the meantime would be welcomed.
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- December 24, 2015 at 10:25 am
Hi again, all … and thanks to those who responded.
Is there anyone about who is good at interpreting path results? I got my results yesterday (December 23) from the four lesions that were excised by a plastic surgeon and snet to a dermatopathology lab here inn Frankfurt, Germany.
They are in German, and I've translated them. Forgice me if the grammar is a bit wobbly, as I'm not used to medical terminology, but the facts are nevertheless still there:
- MICROSCOPY: 7 x 12 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen at the epidermal junction. Melanocytes are observed in the suprabasal layers of the epidermis as well as in the upper dermis. Heavy fibrosis and occasional concomitant inflammatory infiltration are seen.
DIAGNOSIS: Mildly dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 10 x 17 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen. Melanocytes are also seen in the suprabasal layers of the dermis as well as in the upper dermis, with concomitant variable inflammatory infiltration.
DIAGNOSIS: Active junctional melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen in the centre of the sample. Melanocytic proliferation in the suprabasal layers of the epidermis. Nested melanocytes bridging rete ridges. Occasional perivascular, lymphocytic infiltration with melanophages is seen in the dermis.
DIAGNOSIS: Mildly dysplastic melanocytic junctional naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A junctional and nested hyperplasia with enlarged melanocytes is seen. Melanocytes are seen in the suprabasal layers of the epidermis. There is melanocytic bridging of rete ridges. Fibrosis and nests of melanocytes with occasional and variable lymphocytic infiltration are seen in the dermis.
DIAGNOSIS: Dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
The surgeon actually phoned himself yesterday when he received these results, as he said he could see I was very anxious about them. He said 'Good news!'
But it doesn't look all that bright to me! Have to see the dermatologist who spotted these earlier this month (Dec) and referred me for removal. But can't get near him until mid-February, as he is going on holiday and the practice is closed.
Any insights in the meantime would be welcomed.
-
- December 24, 2015 at 10:25 am
Hi again, all … and thanks to those who responded.
Is there anyone about who is good at interpreting path results? I got my results yesterday (December 23) from the four lesions that were excised by a plastic surgeon and snet to a dermatopathology lab here inn Frankfurt, Germany.
They are in German, and I've translated them. Forgice me if the grammar is a bit wobbly, as I'm not used to medical terminology, but the facts are nevertheless still there:
- MICROSCOPY: 7 x 12 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen at the epidermal junction. Melanocytes are observed in the suprabasal layers of the epidermis as well as in the upper dermis. Heavy fibrosis and occasional concomitant inflammatory infiltration are seen.
DIAGNOSIS: Mildly dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 10 x 17 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen. Melanocytes are also seen in the suprabasal layers of the dermis as well as in the upper dermis, with concomitant variable inflammatory infiltration.
DIAGNOSIS: Active junctional melanocytic compound naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A lentiginous and nested melanocytic hyperplasia is seen in the centre of the sample. Melanocytic proliferation in the suprabasal layers of the epidermis. Nested melanocytes bridging rete ridges. Occasional perivascular, lymphocytic infiltration with melanophages is seen in the dermis.
DIAGNOSIS: Mildly dysplastic melanocytic junctional naevus with no evidence of malignancy. The margins are clear.
- MICROSCOPY: 15 x 10 x 3mm surgically excised sample
A junctional and nested hyperplasia with enlarged melanocytes is seen. Melanocytes are seen in the suprabasal layers of the epidermis. There is melanocytic bridging of rete ridges. Fibrosis and nests of melanocytes with occasional and variable lymphocytic infiltration are seen in the dermis.
DIAGNOSIS: Dysplastic melanocytic compound naevus with no evidence of malignancy. The margins are clear.
The surgeon actually phoned himself yesterday when he received these results, as he said he could see I was very anxious about them. He said 'Good news!'
But it doesn't look all that bright to me! Have to see the dermatologist who spotted these earlier this month (Dec) and referred me for removal. But can't get near him until mid-February, as he is going on holiday and the practice is closed.
Any insights in the meantime would be welcomed.
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- December 26, 2015 at 2:51 pm
I think given the fact that the margins are clear on each lesion and that there is no evidence of malignancy on each as well that it is an excellent report! There is nothing further to do in terms of re-excision since you have clear margins and there was no cancer.
I have a *lot* of moles, and my derm regularly lops them off (I just had one taken off my thigh last week) and they ususually come back as atypical or dysplastic, but if they don't say melanoma I don't worry about them. Even when the dermatopathologist says re-excision recommended on some of the funkier ones, so far I just opt for watch and wait for change.
– Paul
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- December 26, 2015 at 2:51 pm
I think given the fact that the margins are clear on each lesion and that there is no evidence of malignancy on each as well that it is an excellent report! There is nothing further to do in terms of re-excision since you have clear margins and there was no cancer.
I have a *lot* of moles, and my derm regularly lops them off (I just had one taken off my thigh last week) and they ususually come back as atypical or dysplastic, but if they don't say melanoma I don't worry about them. Even when the dermatopathologist says re-excision recommended on some of the funkier ones, so far I just opt for watch and wait for change.
– Paul
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- December 26, 2015 at 2:51 pm
I think given the fact that the margins are clear on each lesion and that there is no evidence of malignancy on each as well that it is an excellent report! There is nothing further to do in terms of re-excision since you have clear margins and there was no cancer.
I have a *lot* of moles, and my derm regularly lops them off (I just had one taken off my thigh last week) and they ususually come back as atypical or dysplastic, but if they don't say melanoma I don't worry about them. Even when the dermatopathologist says re-excision recommended on some of the funkier ones, so far I just opt for watch and wait for change.
– Paul
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- December 15, 2015 at 7:55 pm
The simplest and easiest thing to do…is get pictures of your entire body. You can have a dermotologiest do it…or just have your spouse, kid, friend and that will cost absolutely nothing.
You are looking for change…and having a ton of pictures that you can blow up on a 27 inch screen is invaluable. (take about 50-75+ of them every quarter) – the doctor's office is doing the exact same thing.
The key is having both distant and close up shots. Don't forget the hands, feet, and even the ass (got 2 nice moles there I am told).
Best wishes
Michel
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- December 15, 2015 at 7:55 pm
The simplest and easiest thing to do…is get pictures of your entire body. You can have a dermotologiest do it…or just have your spouse, kid, friend and that will cost absolutely nothing.
You are looking for change…and having a ton of pictures that you can blow up on a 27 inch screen is invaluable. (take about 50-75+ of them every quarter) – the doctor's office is doing the exact same thing.
The key is having both distant and close up shots. Don't forget the hands, feet, and even the ass (got 2 nice moles there I am told).
Best wishes
Michel
-
- December 15, 2015 at 7:55 pm
The simplest and easiest thing to do…is get pictures of your entire body. You can have a dermotologiest do it…or just have your spouse, kid, friend and that will cost absolutely nothing.
You are looking for change…and having a ton of pictures that you can blow up on a 27 inch screen is invaluable. (take about 50-75+ of them every quarter) – the doctor's office is doing the exact same thing.
The key is having both distant and close up shots. Don't forget the hands, feet, and even the ass (got 2 nice moles there I am told).
Best wishes
Michel
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- December 15, 2015 at 8:16 pm
The most important thing you could do is exactly what your doing. Having regular skin checks is the key. It’s important to remember that the thing that caused your skin cancer was likely uva from the sun burns. The same conditions that caused your first melanoma could cause additional lesions, however that doesn’t mean your cancer has spread. It’s not unusual to have multiple primaries as time goes on. Even if your additional biopsies come back positive it doesn’t indicate a worse prognosis for you. It sounds like your in good hands medically so just keep faith in your doctors. -
- December 15, 2015 at 8:16 pm
The most important thing you could do is exactly what your doing. Having regular skin checks is the key. It’s important to remember that the thing that caused your skin cancer was likely uva from the sun burns. The same conditions that caused your first melanoma could cause additional lesions, however that doesn’t mean your cancer has spread. It’s not unusual to have multiple primaries as time goes on. Even if your additional biopsies come back positive it doesn’t indicate a worse prognosis for you. It sounds like your in good hands medically so just keep faith in your doctors. -
- December 15, 2015 at 8:16 pm
The most important thing you could do is exactly what your doing. Having regular skin checks is the key. It’s important to remember that the thing that caused your skin cancer was likely uva from the sun burns. The same conditions that caused your first melanoma could cause additional lesions, however that doesn’t mean your cancer has spread. It’s not unusual to have multiple primaries as time goes on. Even if your additional biopsies come back positive it doesn’t indicate a worse prognosis for you. It sounds like your in good hands medically so just keep faith in your doctors.
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