Hope it's OK to post here, I'm wondering how to proceed. Do I see another Derm for another opinion or just go ahead with an excision with 5mm margins as suggested, should I see multiple surgeons? I am close to John's Hopkins so could easily make an appt today with someone!
My mole was removed from a spot approx 2-3 inches below my inside ankle bone, on the side of my foot, but close to the bottom. It's a lot the fact that this area seems to have no meat to remove and lots of possible complications to gain with putting a big hole here that has me really concerned, plus what I'm reading about even severely atypical moles mostly never progressing to melanoma makes this feel really extreme as a treatment, plus I have several more moles on my feet and am just as concerned about them and I know a watch and wait is suggested for most, which seems like under reacting....Here is my path report
Final Diagnosis: Severely atypical compound melanocytic proliferation with spitzoid features; extending very close to the deep margin. See comment.
Comment: This is a difficult case. Initial and multiple levels are examined. Sections show a small, well-circumscribed proliferation of pleomorphic epithelioid melaocytes in the epidermis and dermis. The epidermal component is largely along the junction and is dispersed both as single cells and nests. The proliferation ends laterally in small nests. A rare single cell is noted above the basilar layer of the epidermis; however, fully evolved upward growth in a pagetoid manner is not seen. Pigment is noted in the overlying stratum corneum. The melanocytes are heavily pigmented and demonstrate enlarged nuclei with nucleoli. Similar epithelioid cells are seen within the papillary dermis showing poor maturuation with depth. Dermal mitotic figures are not identified and the proliferative index as denoted by Ki67 immunostaining is not significantly increased. HMB45 immunostain fails to highlight the dermal component of the proliferation. Patchy chronic inflammation and a few pigment-laden macrophaes are seen. Overall although the degree of cytologic atypia is concerning, given the small, well-circumscribed nature of this proliferation and the absence of a significant stromal response or pagetoid growth, the diagnosis of a severely atypical compound melanocytic lesion with spitzoid features is favored over melanoma. In addition, some of the atypia may be related to previous trauma/irritation to the lesion. Nevertheless, as the lesion extends close to the deep margin of the specimen, reexcision is recommended to ensure complete removal and histologic evaluation.
(all underlining was done by hand by my derm)
Any advice would be appreciated. My derm is recommending 5mm margin excision by a plastic surgeon and says to have it handled maybe by January, so not an emergency. I think the foot is not the greatest place to have a big hole, but of course will do what is recommended, but think it prudent to seek out another opinion, I'm just not sure about exactly what? With all the reading on atypical moles, i now recognize that all of my kids have at least one mole that would be classified as atypical....heartburn....
I know that this is not a diagnosed melanoma, but the derm said it went to three pathologists to get a consensus that it was "just" highly atypical. I'm not even sure if there is a true difference or a real difference since treatment is the same as an in situ melanoma. And yes, I am grateful that the diagnosis is not dire, but I'm also confused and worried about the lack of consenses and the fact that I only have one report here based on what was told to me over the phone....Derm says it's good that this is not a cancer diagnosis, but I'm thinking it almost sounds like that's just a technicality?