Need some advice
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Need some advice

› Forums › General Melanoma Community › Need some advice

  • Post
    • June 26, 2013 at 8:05 pm
    Littlea41
    Participant

      Hello.

       

      I was diagnosed with melanoma in-situ on my wrist in march and had it removed as well as the local wide- everything came back clean.

      2 weeks ago I had 2 spots removed from my chest.  One came back OK and the other one came back as the following:

      Pathological Diagnosis: Atypical Compound Melanocylic Nevus with Architectural Disorder and Mild cylologic Atypia, (Dysplastic Nevus), see comments.

      Comments: Margins involved. 

      Hello.

       

      I was diagnosed with melanoma in-situ on my wrist in march and had it removed as well as the local wide- everything came back clean.

      2 weeks ago I had 2 spots removed from my chest.  One came back OK and the other one came back as the following:

      Pathological Diagnosis: Atypical Compound Melanocylic Nevus with Architectural Disorder and Mild cylologic Atypia, (Dysplastic Nevus), see comments.

      Comments: Margins involved. 

      Gross Description: Received in 10% formalin is a shave biopsy measuring .6 cm X .4 cm with a pigmented area measuring .1 cm X .1 cm.

      The doctor doesn't seem to think this is worth doing the local wide on.  I'm concerned because the margins are involved and I'm already a Melanoma patient.  My original melanoma didn't look like a typical melanoma.  in fact, the doctor didn't even want to remove it but I insisted.  I have another spot on my back that is darker then any other mole on my body– again, she didn't want to take that either.  This is a new doctor I am seeing (not the one who removed the melanoma).

      What are your thoughts on getting a second opinion or- having the local wide done on the mild nevus?  I've read that some reports have come back OK but when reviewed by another pathologist, they have concluded melanoma. 

       

      Thanks for your time

    Viewing 5 reply threads
    • Replies
        • June 26, 2013 at 8:31 pm
        Janner
        Participant

          I'd say it was pretty unlikely a mildly atypical nevus would come back as melanoma by another pathologist.  Mildly atypical lesions are basically considered benign. Now if it were severely atypical, that's a different story.  As for getting clean margins, it depends who you talk to.  My melanoma specialist always wants at least clean margins on any atypical lesion.  But there are plenty of doctors who do not feel the same about mildly atypical lesions.  I think you could go either way.  If you do not have the margins taken, then I'd watch the area for any pigment regrowth.  If the lesion starts to grow back, I'd demand it be removed completely at that time.  You should always watch any scar area for pigment regrowth and report that to your doctor if it occurs. 

          Since there is no "standard of care" for mildly atypical lesions, your doctor is not in the wrong.  But in the end, you have to do what makes YOU comfortable.

          Best wishes,

          Janner

          • June 26, 2013 at 8:31 pm
          Janner
          Participant

            I'd say it was pretty unlikely a mildly atypical nevus would come back as melanoma by another pathologist.  Mildly atypical lesions are basically considered benign. Now if it were severely atypical, that's a different story.  As for getting clean margins, it depends who you talk to.  My melanoma specialist always wants at least clean margins on any atypical lesion.  But there are plenty of doctors who do not feel the same about mildly atypical lesions.  I think you could go either way.  If you do not have the margins taken, then I'd watch the area for any pigment regrowth.  If the lesion starts to grow back, I'd demand it be removed completely at that time.  You should always watch any scar area for pigment regrowth and report that to your doctor if it occurs. 

            Since there is no "standard of care" for mildly atypical lesions, your doctor is not in the wrong.  But in the end, you have to do what makes YOU comfortable.

            Best wishes,

            Janner

            • June 26, 2013 at 8:31 pm
            Janner
            Participant

              I'd say it was pretty unlikely a mildly atypical nevus would come back as melanoma by another pathologist.  Mildly atypical lesions are basically considered benign. Now if it were severely atypical, that's a different story.  As for getting clean margins, it depends who you talk to.  My melanoma specialist always wants at least clean margins on any atypical lesion.  But there are plenty of doctors who do not feel the same about mildly atypical lesions.  I think you could go either way.  If you do not have the margins taken, then I'd watch the area for any pigment regrowth.  If the lesion starts to grow back, I'd demand it be removed completely at that time.  You should always watch any scar area for pigment regrowth and report that to your doctor if it occurs. 

              Since there is no "standard of care" for mildly atypical lesions, your doctor is not in the wrong.  But in the end, you have to do what makes YOU comfortable.

              Best wishes,

              Janner

              • June 26, 2013 at 10:19 pm
              JC
              Participant

                To confirm what Janner said and to illustrate the differences among doctrs, my Dr does not go back and re-excise for mildly atypical, even if margins are involved. . .

                • June 26, 2013 at 10:19 pm
                JC
                Participant

                  To confirm what Janner said and to illustrate the differences among doctrs, my Dr does not go back and re-excise for mildly atypical, even if margins are involved. . .

                  • June 26, 2013 at 10:19 pm
                  JC
                  Participant

                    To confirm what Janner said and to illustrate the differences among doctrs, my Dr does not go back and re-excise for mildly atypical, even if margins are involved. . .

                    • June 27, 2013 at 4:32 am
                    Littlea41
                    Participant
                      Thank you very much, I really appreciate you taking the time to post your opinions/thoughts.
                      • June 27, 2013 at 4:32 am
                      Littlea41
                      Participant
                        Thank you very much, I really appreciate you taking the time to post your opinions/thoughts.
                        • June 27, 2013 at 4:32 am
                        Littlea41
                        Participant
                          Thank you very much, I really appreciate you taking the time to post your opinions/thoughts.
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