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WLE for spitz nevus?
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WLE for spitz nevus?

› Forums › Cutaneous Melanoma Community › WLE for spitz nevus?

  • Post
    • November 28, 2018 at 2:40 pm
    tbear
    Participant

      HI!

      I just found out a recent mole I had biopsied came back as a spitz nevus. I haven't seen the pathology report so I don't have much more information than that, but my derm has scheduled me for a WLE next week. He basically said that it wasn't melanoma, but they will treat it like it is. The margins of the punch biopsy were clear.

      I wasn't worried after speaking to my dermatologist, but after reading around the forum, I'm wondering if I should have asked more questions… I'm a 34yo female with a very strong family history of melanoma and have had a few atypical moles myself (mild or moderate). What should I be looking for when I read the pathology report? Are there any questions I should ask? Is it necessary to get a second opinion? Any other advice?

      I'm also curious if I can do a WLE without pain meds – I'm currently breastfeeding and would like to avoid them if possible. 

      Many thanks in advance!

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    • Replies
        • November 28, 2018 at 3:01 pm
        Janner
        Participant

          Spitz nevi are a bit of a wildcard.  They are benign but can look like melanoma under the microscope.  Much depends on the path report but having a WLE is a good choice.  I have had numerous WLEs (10+) without pain meds.  Pain meds make me sick and no point in adding another symptom for me.  Just plan on using some ice packs and babying the area a little.  Ice can be a great pain reliever and also keep swelling down – swelling causes more pain.  Location can dictate more/less pain if the area is stressed by movement. Some people have lower tolerances for pain but for the most part, I think WLEs are uncomfortable but not overly painful.  (I personally have more issues with the adhesive bandages than the actual surgical site)!

          As for a second opinion, it depends a lot on who did the first opinion.  Were they well versed in Spitz Nevi.  Did they do a FSH test?  How deep was the lesion – because if it was just confined to the epidermis, a WLE is all they would do even if it was melanoma.  Talk to your doc about the finer points of the pathology to see his comfort level and then assess yours.

            • November 28, 2018 at 3:27 pm
            tbear
            Participant

              Thank you, Janner. The spot is on my inner thigh, so hopefully should not be too bad, based on what you said. 

              The rest is hard to figure out without the pathology report but they are supposed to send it to me soon, so I'll keep your questions in mind while I look it over. But in terms of your questions… what is an FSH test? And is it the derm or the pathologist that needs to be well versed in spitz nevi? That was the part that was most confusing to me.

              Thanks again! I know this is so minor compared to what so many people are dealing with here, but I appreciate what an incredible resource this board is.

              • November 29, 2018 at 3:33 pm
              tbear
              Participant

                So, I got the pathology report. Learned a lot of new vocabulary. Short version is that it said it is a pagetoid spitz nevus. They had two different pathologists consult and both came to that conclusion although it did mention a possible differential diagnosis of melanoma in situ, which was ruled out. I guess then the WLE is the best course of action because that would be the plan anyways if it were melanoma in situ, right? 

                • November 29, 2018 at 10:30 pm
                Janner
                Participant

                  WLE would be done for melanoma in situ.  WLE as a precaution for Spitz seems a good compromise.

                  • November 30, 2018 at 10:36 am
                  tbear
                  Participant

                    Thanks for weighing in again Janner. I really appreciate it. (Have lurked here for years before posting and learned a lot from you about self detection)

                  • November 29, 2018 at 4:00 pm
                  MMH
                  Participant

                    Hello to you! I had a markedly atypical sitzoid removed in August. They said due to my age (44) it was almost certainly melanoma since spitzoid is unusual in my age bracket.  So, I had the WLE in August and tomorrow I have my first follow-up and of course I am terrified that my lymph nodes are involved.  I have no advice other than to treat it as melanoma and do not worry about the pain of the WLE.  It really was not that bad. I used no pain medication.  All the best to you!  

                      • November 29, 2018 at 4:02 pm
                      MMH
                      Participant

                        And also….in situ is fantastic news! 

                        • November 30, 2018 at 1:58 pm
                        tbear
                        Participant

                          It helps to hear what they decided in your case. I hope your follow-up goes well today! I completely agree, the differential diagnosis as worst case is excellent. And as usual this is all a VERY good reminder to keep doing self-checks and not get behind on appointments.

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