› Forums › Cutaneous Melanoma Community › Severe Mole– Would Pathology Report Notice Regression?
- This topic has 5 replies, 3 voices, and was last updated 7 years, 8 months ago by
Janner.
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- September 21, 2017 at 6:04 pm
When I was 12 or so, I developed a mole on my upper arm near my arm pit. It was an ugly, black cluster of freckles. I remember learning about melanoma at 15 and eyeing that sucker very suspiciously. In my 20s, I gained 100lbs (yeah, I know). That mole now looked more speckled and spread out. The black parts were still black, but there seemed to be more white skin speckled throughout the freckles. I didn't know if it was a change or stretched skin. It took me like 8 years after the changing to get it biopsied. The changing never did seem to get worse. Like it evolved and then stayed steady for the next few years. I showed it to my derm in 2012 and he passed up biopsying it. In 2016 when he took it it was no worse than it'd been in 2012, at least not that I could tell.
The biopsy came back as having moderate-to-severe atypica and being either an atypical lentigo or an evolving junctional nevus, with the first one getting more votes when they reviewed it at conference. It's the UPENN lab, which my derm said is one of the best in the world. The path noted things like focal crowning but does not mention regression anywhere.
Is that something a path could miss or not mention? I had a WLE. It's been gone for a year. But now I'm noticing lots of moles on me fading, and rapidly.
Obvioulsy the cells that were still left on the dermis at the time of extraction are gone. But what about the regressed cells? Could those have moved to other parts of the body, turning or turned into melanoma?
I asked my new derm if maybe it never changed after all. Maybe it looked different because of the weight gain and it was moderate to severe all along. He said no way. Moles never start out severe and it must have been regression.
I am SO WORRIED about developing melanoma without primary that I decided not to have children. I don't know what else to do. If my body is eating the cells instead of keeping them trapped in the skin, how am I supposed to fight this and catch it in its earliest stages?
I know maybe no one can help me. I know maybe I have a bit of health anxiety, but if there's any advice anyone can offer at all, I'd appreciate it.
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- September 21, 2017 at 6:23 pm
So a regressed cell means it is ingested by a macrophage and destroyed. It is not a viable cell and not going to move anywhere else. The immune system destroys it. And yes, regression is something seen and reported on pathology – and yes, UPENN does have a top set of melanoma experts. The theory for unknown primaries are that they regress. However, the melanoma progresses PRIOR to regression. Cells escape before the body recognizes that the lesion needs to go. So the body handles the primary site but not before stuff escapes and goes elsewhere. So the key is watching primary sites – ugly duckling and changing.
Unknown primaries account for a very small set of melanoma individuals and honestly, it is more likely to be found on people who don't have many moles and don't tend to notice them. Why are you convinced you will have melanoma? And if you have lots of moles, then taking pictures of your body noting new and changing moles is the way to go. Regression can happen to anyone and a totally benign mole can regress. It's not uncommon. Essentially, the condition vitiligo is the body destroying melanocytes and that is not related to melanoma. As my melanoma specialist says, it's not uncommon to die of old age without any moles because they have all regressed.
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- September 21, 2017 at 7:13 pm
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.
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- September 22, 2017 at 12:47 am
I think you are stretching things here. A melanoma mole tends to start on the epidermis first and grow "radially". Then it starts a downward progressifor vertical growth phase. Typically that starts in the center and the longer you wait, the more outward and/or deeper in can grow. On the exterior of the lesion, you may find atypical cells or cells of the original nevus that are NOT melanoma. If there is regression, the lab sees the macrophages that eat melanocytes. They don't exactly descriminate between a normal melanocyte, atypical melanocyte or a melanoma melanocyte. They're the cleanup crew. So even if a melanoma cell escapes, it actually doesn't mean that it will setup shop and start growing elsewhere. It can but the body can also identify it and destroy it.
I am just not getting your fear of regression. It seems way out of proportion to the risk. 90% of melanoma start from a known primary. Regression can happen in any type of lesion – it's just the body deciding it doesn't like those cells (benign or cancerous) and destroys it.
It doesn't matter that you didn't start monitoring your moles until now. We were all in that very same position at some point. You start now. You watch from now on. Worrying about the past is pointless. If I could go back 30 years and say be more sun smart, find a better sun block — what do I accomplish? Yes, you are probably higher risk to develop melanoma than the average person. Having more moles or having a family member increases the risk, but it does NOT guarantee it. Each of thoses risks are "relative", not "cummulate" risks. Heck, I have a genetic defect that gave me a 75%+ lifetime risk of developing melanoma. Not all my siblings have developed melanoma. Two of us did at age 29. My mother did at age 70. All of us are early stage years later. My risk of developing another primary is extremely high (I've had 3). You need to get the anxiety under control. You make a plan. You find someone who can do mole mapping if at all possible. You monitor yourself monthly. Take care of the things you CAN control. Do not obsess — you have a plan. Let go the rest.
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- September 21, 2017 at 6:26 pm
If you are so worried about getting melanoma that you have made a huge life decision not to have kids, then you should absolutely seek counseling help for this anxiety. I have stage 4 melanoma and I absolutely 100% plan on having at least one child once I am done getting rid of the melanoma, even though I know it could come back. Melanoma will never stop me from living my life the way I want to. You don't have melanoma, you will likely never have melanoma, so my best advice would be to tackle this anxiety and start living your life the way YOU want to live it!
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- September 21, 2017 at 7:24 pm
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 🙂
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