Questions before first consult
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Questions before first consult

› Forums › General Melanoma Community › Questions before first consult

  • Post
    • January 26, 2014 at 1:33 am
    uhoh
    Participant

      Hello,
      My new PCP wants me to be seen asap for a suspicious melanoma and not even wait the usual 3-4 months for an appointment. I have had this lesion for years and I can't remember how or when it may have changed. Due to another cancer I have just completed treatment for, this PCP is not ignoring the potential for another cancer. The good news he said is that I've had this 'whatever it is' for years now (ignored several times by another Dr I showed it to), but we know now that I am one who already has had cancer. 

      There is a near by plastic surgeon at a community hospital who has multiple openings in his schedule. I like community hospitals and docs. I also want the best diagnosis and treatment. I live a few minutes from an NCCN center where I already see a gyne oncologist.

      So far I do not have confidence in the plastic surgeon I have an appointment with. Funny, that I had a choice of appointments for the following day and several other optins for the next few days is somehow not comforting. The plastic surgeon has not published in around 30 yrs and I know that should not indicate his skill and knowledge, but I can't find anything about this Dr except that he is licensed.

      How important is it that I see a specialist for an initial consult? How important is it for a specialist to perform a biopsy, or excision? Is the Mohs procedure done on flat upper arm lesions? Would a Dr do a biopsy first and then decide on excision vs Mohs?

      What are some questions I might ask during the first consult. I am not even sure if I'll keep the appointment or try to find another Dr. first.

      Thanks.

       

    Viewing 14 reply threads
    • Replies
        • January 26, 2014 at 1:40 am
        uhoh
        Participant

          Also, are whole or unprocessed samples ever used for vaccine or other personalize therapies where fresh tumor is required for analysis? Like by the time I found out about a vaccine that could be made from my solid tumor, only preserved slides and blocks remained. 

          Or would something like this be of importance depending on the staging?

          • January 26, 2014 at 1:40 am
          uhoh
          Participant

            Also, are whole or unprocessed samples ever used for vaccine or other personalize therapies where fresh tumor is required for analysis? Like by the time I found out about a vaccine that could be made from my solid tumor, only preserved slides and blocks remained. 

            Or would something like this be of importance depending on the staging?

            • January 26, 2014 at 1:40 am
            uhoh
            Participant

              Also, are whole or unprocessed samples ever used for vaccine or other personalize therapies where fresh tumor is required for analysis? Like by the time I found out about a vaccine that could be made from my solid tumor, only preserved slides and blocks remained. 

              Or would something like this be of importance depending on the staging?

              • January 26, 2014 at 1:57 am
              JerryfromFauq
              Participant

                For an unkonown Derm, you should make sure that removal of the mole is not done without removing the entire "mole", not just do a shave biopsy.  If it is melanoma, they will go back in and take wider margins.(WLE).  There should not be a problem with any competent surgeon doing the initial biopsy.  Do get copies of the surgical report and pathology report.

                 

                • January 26, 2014 at 1:57 am
                JerryfromFauq
                Participant

                  For an unkonown Derm, you should make sure that removal of the mole is not done without removing the entire "mole", not just do a shave biopsy.  If it is melanoma, they will go back in and take wider margins.(WLE).  There should not be a problem with any competent surgeon doing the initial biopsy.  Do get copies of the surgical report and pathology report.

                   

                  • January 26, 2014 at 1:57 am
                  JerryfromFauq
                  Participant

                    For an unkonown Derm, you should make sure that removal of the mole is not done without removing the entire "mole", not just do a shave biopsy.  If it is melanoma, they will go back in and take wider margins.(WLE).  There should not be a problem with any competent surgeon doing the initial biopsy.  Do get copies of the surgical report and pathology report.

                     

                      • January 26, 2014 at 3:00 am
                      uhoh
                      Participant

                        Thanks Jerry. Your reply was VERY helpful. So only after pathology has a look will they go back to make sure the margins are clean. I think you are saying that an inital biopsy should also be removal of the mole.

                        If if is melanoma, then would I benefit from a specialist?

                        The area in question is larger than I recall when I first noticed it a few years ago. There are two brown/black moles, perhaps 1.5" apart. And now there is a salmon colored area in the gap and below. Is it likely the Dr would want to remove this large area in the office, same day? I am asking because it would be easier for me to have a sore arm the following week.  

                        Thanks

                        • January 26, 2014 at 3:00 am
                        uhoh
                        Participant

                          Thanks Jerry. Your reply was VERY helpful. So only after pathology has a look will they go back to make sure the margins are clean. I think you are saying that an inital biopsy should also be removal of the mole.

                          If if is melanoma, then would I benefit from a specialist?

                          The area in question is larger than I recall when I first noticed it a few years ago. There are two brown/black moles, perhaps 1.5" apart. And now there is a salmon colored area in the gap and below. Is it likely the Dr would want to remove this large area in the office, same day? I am asking because it would be easier for me to have a sore arm the following week.  

                          Thanks

                          • January 26, 2014 at 3:00 am
                          uhoh
                          Participant

                            Thanks Jerry. Your reply was VERY helpful. So only after pathology has a look will they go back to make sure the margins are clean. I think you are saying that an inital biopsy should also be removal of the mole.

                            If if is melanoma, then would I benefit from a specialist?

                            The area in question is larger than I recall when I first noticed it a few years ago. There are two brown/black moles, perhaps 1.5" apart. And now there is a salmon colored area in the gap and below. Is it likely the Dr would want to remove this large area in the office, same day? I am asking because it would be easier for me to have a sore arm the following week.  

                            Thanks

                            • January 26, 2014 at 3:44 am
                            JerryfromFauq
                            Participant

                              It will depend on what the surgeon thinks. Probably not take the whole area the first time.  My general surgeon saw two more close spots and waited 2 months after the diagnoses to finally take them!  You should get the pathology report in about a week.  It it is melanoma, make sure that the dye is injected to trace the lymph path to the correct sentinal lymph node (SLN) before the actual WLE.  Whether or not a specialist is needed then can vary, depending on the thicknes/depth of the tumor.  If less than 1 mm and not ulcerated, they will likely not do the SLN.  I would prefer a Melanoma specialist if they remove the SLN. 

                              • January 26, 2014 at 3:44 am
                              JerryfromFauq
                              Participant

                                It will depend on what the surgeon thinks. Probably not take the whole area the first time.  My general surgeon saw two more close spots and waited 2 months after the diagnoses to finally take them!  You should get the pathology report in about a week.  It it is melanoma, make sure that the dye is injected to trace the lymph path to the correct sentinal lymph node (SLN) before the actual WLE.  Whether or not a specialist is needed then can vary, depending on the thicknes/depth of the tumor.  If less than 1 mm and not ulcerated, they will likely not do the SLN.  I would prefer a Melanoma specialist if they remove the SLN. 

                                • January 26, 2014 at 3:44 am
                                JerryfromFauq
                                Participant

                                  It will depend on what the surgeon thinks. Probably not take the whole area the first time.  My general surgeon saw two more close spots and waited 2 months after the diagnoses to finally take them!  You should get the pathology report in about a week.  It it is melanoma, make sure that the dye is injected to trace the lymph path to the correct sentinal lymph node (SLN) before the actual WLE.  Whether or not a specialist is needed then can vary, depending on the thicknes/depth of the tumor.  If less than 1 mm and not ulcerated, they will likely not do the SLN.  I would prefer a Melanoma specialist if they remove the SLN. 

                                • January 26, 2014 at 3:32 am
                                POW
                                Participant

                                  If your mole is changing, which it sounds like yours is, it should be biopsied. But it should always be a punch biopsy. If it is melanoma, it is critical to get an accurate Breslow depth which is best done with a punch biopsy. Some dermatologists use a "deep shave" or "scalloped shave" for small moles. But never a MOHS. 

                                  If you have a choice, it would be best if you go to a dermatologist who has a lot of experience with melanoma; plastic surgery is somewhat different. You might be seeing this person regularly for quite a while to check your skin and lymph nodes and it would be best to have a doctor experienced with melanoma to do that.

                                  Once the path report comes back, get a copy of it — always get copies of all of your medical records, lab tests and CDs of your scan images. This is probably NOT melanoma; most biopsies are negative for melanoma. But if it is melanoma, you will then have a Wide Local Excision (WLE) and, if necessary, a Sentinel Node Biopsy (SNB). If you post your path report here, we will try to answer any questions you have about it. 

                                  Don't get ahead of yourself– you really don't know yet what is going on. Just take things one step at a time and don't hesitate to ask questions of your doctor or of us. But, really, there's not much you can ask at least until you get your biopsy result and, if necessary, a WLE.

                                  • January 26, 2014 at 3:32 am
                                  POW
                                  Participant

                                    If your mole is changing, which it sounds like yours is, it should be biopsied. But it should always be a punch biopsy. If it is melanoma, it is critical to get an accurate Breslow depth which is best done with a punch biopsy. Some dermatologists use a "deep shave" or "scalloped shave" for small moles. But never a MOHS. 

                                    If you have a choice, it would be best if you go to a dermatologist who has a lot of experience with melanoma; plastic surgery is somewhat different. You might be seeing this person regularly for quite a while to check your skin and lymph nodes and it would be best to have a doctor experienced with melanoma to do that.

                                    Once the path report comes back, get a copy of it — always get copies of all of your medical records, lab tests and CDs of your scan images. This is probably NOT melanoma; most biopsies are negative for melanoma. But if it is melanoma, you will then have a Wide Local Excision (WLE) and, if necessary, a Sentinel Node Biopsy (SNB). If you post your path report here, we will try to answer any questions you have about it. 

                                    Don't get ahead of yourself– you really don't know yet what is going on. Just take things one step at a time and don't hesitate to ask questions of your doctor or of us. But, really, there's not much you can ask at least until you get your biopsy result and, if necessary, a WLE.

                                    • January 26, 2014 at 3:32 am
                                    POW
                                    Participant

                                      If your mole is changing, which it sounds like yours is, it should be biopsied. But it should always be a punch biopsy. If it is melanoma, it is critical to get an accurate Breslow depth which is best done with a punch biopsy. Some dermatologists use a "deep shave" or "scalloped shave" for small moles. But never a MOHS. 

                                      If you have a choice, it would be best if you go to a dermatologist who has a lot of experience with melanoma; plastic surgery is somewhat different. You might be seeing this person regularly for quite a while to check your skin and lymph nodes and it would be best to have a doctor experienced with melanoma to do that.

                                      Once the path report comes back, get a copy of it — always get copies of all of your medical records, lab tests and CDs of your scan images. This is probably NOT melanoma; most biopsies are negative for melanoma. But if it is melanoma, you will then have a Wide Local Excision (WLE) and, if necessary, a Sentinel Node Biopsy (SNB). If you post your path report here, we will try to answer any questions you have about it. 

                                      Don't get ahead of yourself– you really don't know yet what is going on. Just take things one step at a time and don't hesitate to ask questions of your doctor or of us. But, really, there's not much you can ask at least until you get your biopsy result and, if necessary, a WLE.

                                      • January 26, 2014 at 4:00 am
                                      Janner
                                      Participant

                                        Personally, I would be fine with a plastic surgeon.  I'd want a punch or excision all biopsy.  But more important  is where they send the pathology.  You want a dermatopathologist reading your slides.  Plenty of time gor a derm or specialist later if this is really melanoma.  The diagnosis is more important now, then you get your results and go from there.  So if this were melanoma, eArly lesions might only require a derm while other lesions might require a specialist.  But until you know what you are dealing with, a plastic surgeon doing a biopsy makes sense to me.

                                        • January 26, 2014 at 4:00 am
                                        Janner
                                        Participant

                                          Personally, I would be fine with a plastic surgeon.  I'd want a punch or excision all biopsy.  But more important  is where they send the pathology.  You want a dermatopathologist reading your slides.  Plenty of time gor a derm or specialist later if this is really melanoma.  The diagnosis is more important now, then you get your results and go from there.  So if this were melanoma, eArly lesions might only require a derm while other lesions might require a specialist.  But until you know what you are dealing with, a plastic surgeon doing a biopsy makes sense to me.

                                          • January 26, 2014 at 4:00 am
                                          Janner
                                          Participant

                                            Personally, I would be fine with a plastic surgeon.  I'd want a punch or excision all biopsy.  But more important  is where they send the pathology.  You want a dermatopathologist reading your slides.  Plenty of time gor a derm or specialist later if this is really melanoma.  The diagnosis is more important now, then you get your results and go from there.  So if this were melanoma, eArly lesions might only require a derm while other lesions might require a specialist.  But until you know what you are dealing with, a plastic surgeon doing a biopsy makes sense to me.

                                              • January 26, 2014 at 4:29 am
                                              uhoh
                                              Participant

                                                Of course, I'm so glad you mentioned the pathology. Should I keep my appointment with the Plastic Surgeon I'll make sure the lesions are sent outside, probably to the local NCCN hospital. I know how important pathology services are as the cancer I just treated has had two very different path reports…actually three, two with a favorable prognosis 🙂

                                                My PCP made the referrel to this plastic surgeon in part because he is availalbe and due to the overall size of the mole area. I am 59, the moles are on my upper arm, and I really don't care what it looks like after the removal.

                                                • January 26, 2014 at 4:29 am
                                                uhoh
                                                Participant

                                                  Of course, I'm so glad you mentioned the pathology. Should I keep my appointment with the Plastic Surgeon I'll make sure the lesions are sent outside, probably to the local NCCN hospital. I know how important pathology services are as the cancer I just treated has had two very different path reports…actually three, two with a favorable prognosis 🙂

                                                  My PCP made the referrel to this plastic surgeon in part because he is availalbe and due to the overall size of the mole area. I am 59, the moles are on my upper arm, and I really don't care what it looks like after the removal.

                                                  • January 26, 2014 at 4:29 am
                                                  uhoh
                                                  Participant

                                                    Of course, I'm so glad you mentioned the pathology. Should I keep my appointment with the Plastic Surgeon I'll make sure the lesions are sent outside, probably to the local NCCN hospital. I know how important pathology services are as the cancer I just treated has had two very different path reports…actually three, two with a favorable prognosis 🙂

                                                    My PCP made the referrel to this plastic surgeon in part because he is availalbe and due to the overall size of the mole area. I am 59, the moles are on my upper arm, and I really don't care what it looks like after the removal.

                                                    • January 26, 2014 at 7:32 pm
                                                    hbecker
                                                    Participant

                                                      Some plastic surgeons are very experienced in doing cancer surgery, removing lesions and doing skin grafts if the patch is too big for sutures. Sometimes they work in tandem with oncological surgeons. But if he's someone who primarily does cosmetic surgery, then you might want to look for someone else.

                                                      Good luck – keep us posted.

                                                      ~Hazel

                                                      • January 26, 2014 at 7:32 pm
                                                      hbecker
                                                      Participant

                                                        Some plastic surgeons are very experienced in doing cancer surgery, removing lesions and doing skin grafts if the patch is too big for sutures. Sometimes they work in tandem with oncological surgeons. But if he's someone who primarily does cosmetic surgery, then you might want to look for someone else.

                                                        Good luck – keep us posted.

                                                        ~Hazel

                                                        • January 26, 2014 at 7:32 pm
                                                        hbecker
                                                        Participant

                                                          Some plastic surgeons are very experienced in doing cancer surgery, removing lesions and doing skin grafts if the patch is too big for sutures. Sometimes they work in tandem with oncological surgeons. But if he's someone who primarily does cosmetic surgery, then you might want to look for someone else.

                                                          Good luck – keep us posted.

                                                          ~Hazel

                                                        • July 4, 2014 at 2:42 am
                                                        uhoh
                                                        Participant

                                                          Follow-up, and thanks for your help. It turns out I have Superficial spreading malignant melanoma stage 1a from the biopsy. I had a wide excision today ans expect to have the path report next week.

                                                          Where the site biopsy was taken, the site ulcerated. I'm curious and concerned about this. 

                                                           

                                                          Thanks

                                                          • July 4, 2014 at 2:42 am
                                                          uhoh
                                                          Participant

                                                            Follow-up, and thanks for your help. It turns out I have Superficial spreading malignant melanoma stage 1a from the biopsy. I had a wide excision today ans expect to have the path report next week.

                                                            Where the site biopsy was taken, the site ulcerated. I'm curious and concerned about this. 

                                                             

                                                            Thanks

                                                            • July 4, 2014 at 2:42 am
                                                            uhoh
                                                            Participant

                                                              Follow-up, and thanks for your help. It turns out I have Superficial spreading malignant melanoma stage 1a from the biopsy. I had a wide excision today ans expect to have the path report next week.

                                                              Where the site biopsy was taken, the site ulcerated. I'm curious and concerned about this. 

                                                               

                                                              Thanks

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