Here I am again
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Here I am again

› Forums › Cutaneous Melanoma Community › Here I am again

  • Post
    • July 16, 2013 at 10:25 pm
    casagrayson
    Participant

      Short bio:  Husband has had two primaries, both Stage 1 (one with some mitotic activity).  He has had many more BCC and squamous, and this year alone has had 5 Mohs procedures.  The last surgeries were for nodular cancers which were (finally) diagnosed as recurrent BCC, even though he never had any cancer/surgeries in that area.  

      Latest derm visit found another suspicious spot.  Biopsied, with the following pathology:

      Short bio:  Husband has had two primaries, both Stage 1 (one with some mitotic activity).  He has had many more BCC and squamous, and this year alone has had 5 Mohs procedures.  The last surgeries were for nodular cancers which were (finally) diagnosed as recurrent BCC, even though he never had any cancer/surgeries in that area.  

      Latest derm visit found another suspicious spot.  Biopsied, with the following pathology:

      "The speciment is a shave biopsy of skin present as multiple H&E stained sections on one slide.  Cytologic atypia is present and manifests as large nuclei, pleomorphism, and abnormal chromatin patterns.  No atypical mitotic figures are identified.  Architectural disorder is present and manifests as lentiginous hyperplasia, horizontal growth pattern, individual melanocytic hyperplasia and abnormal formed junctional nests that focally demonstrate bridging adjacent rete ridges.  There is an incidental angioma.  The melanocytic process extends to the deep and one lateral surgical margins."

      No stains were performed.

      The doctor's scheduler called today, said the doctor wanted to do a WLE, and we have an appointment in two weeks.

       

      Here's my question.  In a person who has already had two primary melanomas, and who has had other "unusual" pathologies (they were worried about Merkel cell carcinoma or spindle cell, and quite frankly, never did come up with an answer that satisfied me), should we be dealing with a melanoma specialist instead of just a dermatologist (albeit a pretty good one, I think)?  Is there any reason we should be acting more aggressively (i.e. SNB or scans of any sort)?  I feel as if he is a ticking time bomb, and I want to proceed with the greatest amount of caution without "borrowing trouble".

       

      Susan

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    • Replies
        • July 17, 2013 at 1:55 am
        Janner
        Participant

          Why is the derm still doing shave biopsies?  Personally, I'd want him/her to do a biopsy that had a full skin thickness on anything pigmented – either a punch or excision.  It's hard when there are a lot of biopsies happening but this shave did have involved deep margins.  If this had been melanoma, then the depth might have been compromised because the lesion was bisected.  Some people don't mind shave biopsies, but I'm not a fan.  Just a personal comment.

          So, this is just an atypical lesion and there would be no need for anything other than complete removal.  There is no need to do a SNB on a lesion that is not cancer.  A SNB is basically a staging tool only and isn't really a "treatment" anyway.  As for scans, they don't pick up anything microscopic.  So unless there is an actual tumor somewhere, scans are useless. 

          As for a specialist, I went to a cutaneous oncologist after my second primary.  This is a derm that specializes in skin cancer only and does nothing else.  He's located at a cancer center so good access to other specialists if it were needed.  He is a Mohs surgeon and is a big fan of mole mapping – using photography to watch for change.  With all the issues your husband is having, that might be a good move if you have one in your area.  An melanoma oncologist isn't going to have a lot to offer you because there are no treatments for stage I.  You really want someone who can keep up with all the stuff on his skin and truthfully, that is more a "derm" than an "oncologist".  Preferably a derm more interested in cancer than botox.

          Best wishes,

          Janner

          • July 17, 2013 at 1:55 am
          Janner
          Participant

            Why is the derm still doing shave biopsies?  Personally, I'd want him/her to do a biopsy that had a full skin thickness on anything pigmented – either a punch or excision.  It's hard when there are a lot of biopsies happening but this shave did have involved deep margins.  If this had been melanoma, then the depth might have been compromised because the lesion was bisected.  Some people don't mind shave biopsies, but I'm not a fan.  Just a personal comment.

            So, this is just an atypical lesion and there would be no need for anything other than complete removal.  There is no need to do a SNB on a lesion that is not cancer.  A SNB is basically a staging tool only and isn't really a "treatment" anyway.  As for scans, they don't pick up anything microscopic.  So unless there is an actual tumor somewhere, scans are useless. 

            As for a specialist, I went to a cutaneous oncologist after my second primary.  This is a derm that specializes in skin cancer only and does nothing else.  He's located at a cancer center so good access to other specialists if it were needed.  He is a Mohs surgeon and is a big fan of mole mapping – using photography to watch for change.  With all the issues your husband is having, that might be a good move if you have one in your area.  An melanoma oncologist isn't going to have a lot to offer you because there are no treatments for stage I.  You really want someone who can keep up with all the stuff on his skin and truthfully, that is more a "derm" than an "oncologist".  Preferably a derm more interested in cancer than botox.

            Best wishes,

            Janner

            • July 17, 2013 at 1:55 am
            Janner
            Participant

              Why is the derm still doing shave biopsies?  Personally, I'd want him/her to do a biopsy that had a full skin thickness on anything pigmented – either a punch or excision.  It's hard when there are a lot of biopsies happening but this shave did have involved deep margins.  If this had been melanoma, then the depth might have been compromised because the lesion was bisected.  Some people don't mind shave biopsies, but I'm not a fan.  Just a personal comment.

              So, this is just an atypical lesion and there would be no need for anything other than complete removal.  There is no need to do a SNB on a lesion that is not cancer.  A SNB is basically a staging tool only and isn't really a "treatment" anyway.  As for scans, they don't pick up anything microscopic.  So unless there is an actual tumor somewhere, scans are useless. 

              As for a specialist, I went to a cutaneous oncologist after my second primary.  This is a derm that specializes in skin cancer only and does nothing else.  He's located at a cancer center so good access to other specialists if it were needed.  He is a Mohs surgeon and is a big fan of mole mapping – using photography to watch for change.  With all the issues your husband is having, that might be a good move if you have one in your area.  An melanoma oncologist isn't going to have a lot to offer you because there are no treatments for stage I.  You really want someone who can keep up with all the stuff on his skin and truthfully, that is more a "derm" than an "oncologist".  Preferably a derm more interested in cancer than botox.

              Best wishes,

              Janner

              • July 17, 2013 at 3:55 am
              casagrayson
              Participant

                Thanks, Janner.  You've talked me down from the ledge once again.  I did a little research, and we do have a cutaneous oncologist about an hour away from us, and as it turns out this is the facility that performs all pathology reports.  I feel a bit better about the whole situation.  The dermatologist is really caring and is extremely well-trained (Harvard) so I should quit second-guessing.  OTOH, my husband is not one to stay on top of this stuff; he'd much rather bury his head in the sand.  I guess if you put the two of us together (one medical information junkie and one ostrich) we make one normal person.  🙂

                • July 17, 2013 at 3:55 am
                casagrayson
                Participant

                  Thanks, Janner.  You've talked me down from the ledge once again.  I did a little research, and we do have a cutaneous oncologist about an hour away from us, and as it turns out this is the facility that performs all pathology reports.  I feel a bit better about the whole situation.  The dermatologist is really caring and is extremely well-trained (Harvard) so I should quit second-guessing.  OTOH, my husband is not one to stay on top of this stuff; he'd much rather bury his head in the sand.  I guess if you put the two of us together (one medical information junkie and one ostrich) we make one normal person.  🙂

                  • July 17, 2013 at 3:55 am
                  casagrayson
                  Participant

                    Thanks, Janner.  You've talked me down from the ledge once again.  I did a little research, and we do have a cutaneous oncologist about an hour away from us, and as it turns out this is the facility that performs all pathology reports.  I feel a bit better about the whole situation.  The dermatologist is really caring and is extremely well-trained (Harvard) so I should quit second-guessing.  OTOH, my husband is not one to stay on top of this stuff; he'd much rather bury his head in the sand.  I guess if you put the two of us together (one medical information junkie and one ostrich) we make one normal person.  🙂

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