› Forums › General Melanoma Community › Previous Melanoma In Situ patient…biopsy of mole came back atypical they want to punch biopsy
- This topic has 12 replies, 4 voices, and was last updated 11 years, 11 months ago by
d0771.
- Post
-
- October 7, 2013 at 10:24 pm
For a quick rundown of my history
11/2012
Visited derm for something I thought could be melanoma, but was actually a benign keratosis. While I was there, they did biopsy two moles. One came back a mild atypia, other came back benign.
9/2013, during a routine exam, a biopsy was performed, and it came back melanoma in situ, that was then wide excised, and came back with clean margins, at the same time, another mole on my leg was biopsied and came back mildly displastic.
late 9/2013 – Went in for my full body exam, one mole biopsied, was notified it was mildly atypical, and they want to punch biopsy it.
So I am looking for a little bit of knowledge / advice on this. I just spoke to the nurse, and basically asked why if one on my side that was mildly atypical has not been punch biopsied, why would the one on my back need to be? Just to be clear, I was not asking this from the perspective of being a difficult patient and going against doctors orders, just the opposite. My concern is that we are simply monitoring the atypia on my side, but in reality, should that one be punched as well now that it turns out I had melanoma? From everything I understand, I am just looking to make sure that no pigment is coming back to the one on my side, which I check regularly. So, other than the location on my back being much harder to closely monitor than my side (out of sight out of mind), is there any other reason to punch biopsy it?
Basically, if you have an atypical, are you trying to achieve the same results as with the melanoma and the wide excision? Is the next step a wide excision of my mildly atypical mole?
Just trying to get a little firmer grasp on what I am dealing with. From what I understand yes, atypicals can turn into melanoma, but usually melanoma basically starts out as melanoma in a new spot. Of course, I know my chances are increased now that I have been previously diagnosed, but just looking for some clarity.
Thank you for reading my long thread and any thoughts you can share.
- Replies
-
-
- October 7, 2013 at 11:23 pm
You are correct. Mild to moderate atypias do not become melanoma; severe atypias can eventually develop into melanoma but that takes a long time.
The reason to do a punch biopsy is to make sure you get the whole depth of the lesion. If it does turn out to be melanoma, the Breslow depth is an important prognostic indicator. A shave biopsy is much shallower than a punch biopsy. However, since melanoma in situ is confined to the epidermal layer of the skin, a shave biopsy will get all of it with no problem. You don't need a punch biopsy for that.
The choice of shave or punch can be tricky. So far you seem to have a good dermatologist who is watching things carefully and removing anything that looks the least bit suspicious. That's good. And in a case like that, shave biopsies are probably fine. There is actually an in-between technique called a "deep shave" or "scallop" biopsy. That might be a good compromise for you. Talk to your dermatologist about that.
But if you are really worried about melanoma and you have a lesion that is large, growing, changing color, itching or bleeding, I would insist on a punch biopsy. Just to be on the safe side.
-
- October 7, 2013 at 11:23 pm
You are correct. Mild to moderate atypias do not become melanoma; severe atypias can eventually develop into melanoma but that takes a long time.
The reason to do a punch biopsy is to make sure you get the whole depth of the lesion. If it does turn out to be melanoma, the Breslow depth is an important prognostic indicator. A shave biopsy is much shallower than a punch biopsy. However, since melanoma in situ is confined to the epidermal layer of the skin, a shave biopsy will get all of it with no problem. You don't need a punch biopsy for that.
The choice of shave or punch can be tricky. So far you seem to have a good dermatologist who is watching things carefully and removing anything that looks the least bit suspicious. That's good. And in a case like that, shave biopsies are probably fine. There is actually an in-between technique called a "deep shave" or "scallop" biopsy. That might be a good compromise for you. Talk to your dermatologist about that.
But if you are really worried about melanoma and you have a lesion that is large, growing, changing color, itching or bleeding, I would insist on a punch biopsy. Just to be on the safe side.
-
- October 7, 2013 at 11:23 pm
You are correct. Mild to moderate atypias do not become melanoma; severe atypias can eventually develop into melanoma but that takes a long time.
The reason to do a punch biopsy is to make sure you get the whole depth of the lesion. If it does turn out to be melanoma, the Breslow depth is an important prognostic indicator. A shave biopsy is much shallower than a punch biopsy. However, since melanoma in situ is confined to the epidermal layer of the skin, a shave biopsy will get all of it with no problem. You don't need a punch biopsy for that.
The choice of shave or punch can be tricky. So far you seem to have a good dermatologist who is watching things carefully and removing anything that looks the least bit suspicious. That's good. And in a case like that, shave biopsies are probably fine. There is actually an in-between technique called a "deep shave" or "scallop" biopsy. That might be a good compromise for you. Talk to your dermatologist about that.
But if you are really worried about melanoma and you have a lesion that is large, growing, changing color, itching or bleeding, I would insist on a punch biopsy. Just to be on the safe side.
-
- October 7, 2013 at 11:32 pm
Not sure but I would ask why they aren’t being consistent in treating the moles. I don’t think they are worried about any mildly atypical lesion becoming melanoma. But I’m with you, I’d either have them both removed with clear margins or neither. And I’d ask the doctor, not the nurse.-
- October 8, 2013 at 3:11 pm
I guess they are being consistant in the sense that, at the time of my first atypia, I never had melanoma, so they just did a watch and wait. The one on my leg had atypical features, but was not atypical on the cellular level, so watch and wait. As far as on my back, now that I have had previous melanoma, they are going to do a punch just to be sure they got all of it.
I am going in for my punch on Friday, so I will talk to the doctor about everything in detail then.
-
- October 8, 2013 at 3:11 pm
I guess they are being consistant in the sense that, at the time of my first atypia, I never had melanoma, so they just did a watch and wait. The one on my leg had atypical features, but was not atypical on the cellular level, so watch and wait. As far as on my back, now that I have had previous melanoma, they are going to do a punch just to be sure they got all of it.
I am going in for my punch on Friday, so I will talk to the doctor about everything in detail then.
-
- October 8, 2013 at 3:11 pm
I guess they are being consistant in the sense that, at the time of my first atypia, I never had melanoma, so they just did a watch and wait. The one on my leg had atypical features, but was not atypical on the cellular level, so watch and wait. As far as on my back, now that I have had previous melanoma, they are going to do a punch just to be sure they got all of it.
I am going in for my punch on Friday, so I will talk to the doctor about everything in detail then.
-
- October 7, 2013 at 11:32 pm
Not sure but I would ask why they aren’t being consistent in treating the moles. I don’t think they are worried about any mildly atypical lesion becoming melanoma. But I’m with you, I’d either have them both removed with clear margins or neither. And I’d ask the doctor, not the nurse. -
- October 7, 2013 at 11:32 pm
Not sure but I would ask why they aren’t being consistent in treating the moles. I don’t think they are worried about any mildly atypical lesion becoming melanoma. But I’m with you, I’d either have them both removed with clear margins or neither. And I’d ask the doctor, not the nurse.
Tagged: cutaneous melanoma
- You must be logged in to reply to this topic.