Home Forums Melanoma Diagnosis: Stages I &II Mole lost on the way to the dermatopathologist- what now?

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  • #21248
    toastwave
    Participant

    Hi all,

    So…I went to my first derm. appointment at John’s Hopkins. The new derm seems good and we got along fine. I will be alternating between her and the melanoma clinic at JH every three months. She looked at a bunch of moles that have gotten a bit darker and three that have changed in the past three months. My skin is a mess here in late pregnancy so it is hard to tell what is what. Anyway, she decided, esp. since she does not know my skin well, to biopsy two that had developed black spots in the middle (I think all my moles are atypical). One came back mild! The other…was…lost?!?!?! What?!?! Yes, you read that right, it was lost before they could look at it. So now I have to decide what to do based on the following info:

    1) It looked substantially similar to the one on my chest that came back mild (but that is according to others since I could not ever really see that mole)

    2) It is highly unlikely it is melanoma.

    3) They don’t know if they got the margins.

    My options are:

    1) Treat it like a moderate and re-excise (any stray weird cells should at least come up in the sample)

    2) Treat it like a severe and do a .5 cm re-excision- this seems heavy-handed to me since I am now at 2 WLEs and, though not vain, certainly do not want to get a scar for the hell of it

    3) Treat it like a melanoma and do a 1cm re-excision- same thoughts as before but seems even more dramatic

    4) Do nothing

    Honestly, I want to just do nothing but, given my young age and the age of my 1.75 kids, prob. I should go with #1?

    What do you all think? What would you do?

    #60503
    cohanja
    Participant

    I can only answer for my own situation which may be different from yours. Since my melanoma diagnosis almost 2 years ago, I’ve had probably 50 biopsies, all benign, nothing that needed to be re-excised. If they did yet another biopsy on something that looked like all the rest of the others that have been done in the last 2 years, and lost the sample. .once I stopped being upset about that (it’s really unacceptable), I probably would opt to do the same thing as was done with all the prior ones. Of course that is easier said than done, because that one will be the one that you worry about and think about all the time. So ultimately you have to do whatever brings you peace of mind, and whatever you and your Dr decide is best. I think we all err on the side of caution with melanoma, sometimes even to extremes (I’ve had CT scans, etc. . ).

    #60504
    Jenni
    Participant

    Toastwave,

    Wow, that sucks!!! Lost, wth?! BUT, to answer your question (as a fellow pregnant mommy that has weird changing moles too) I would go with option #1, a small re-excision to get the rest, if any, and then at least feel at ease it is gone. I am sure it is probably just the hormones making it change (especially in the end of pregnancy) and that it is not melanoma. BUT, to make your mind rest easy, get a small re-excision, NOT a WLE, that seems like overkill for sure.

    Good luck in the last days, I know how uncomfortable those are!! AND I will get to experience that with TWO, someday soon. I am 10 weeks (still sick, yuck)!

    Best,

    Jenni

    #60505
    dk06
    Participant

    I’ve had a biopsy where part of it did not survive processing, but lost? That is just not acceptable!

    I would probably just have a re-excision, not a WLE, as others have said.

    I do have some questions for those of you who are pregnant. Are you all seeing a lot of your moles change? Are you having biopsies on anything that changes? We are not trying yet, but one of my fears is being able to keep track of all the mole changes. I know this is different in each person. Change is really the key thing for me to go by since I have moles with varying colors and that are asymmetrical which come back completely normal.

    I also have a few moles on my stomach that we are watching carefully, but have not removed since they have been stable. I’m contemplating just getting them removed though before pregnancy.

    Congrats to you both Jenni and Toastwave…how exciting!

    #60506
    Jenni
    Participant

    As to your questions, DK06, I am 10 weeks pregnant and although I haven’t done a skin check since I found out I was pregnant (I have been too sick to even think about it, but will do one this weekend against my pictures), I have been watching my skin for change (since I know my arms moles fairly well and my belly ones, and so far all looks stable from what I remember). However, when I was pregnant with Alex, my first daughter, who is almost 2.5 yrs old now, I was seeing a few changes in the beginning but this was also just a few months after my melanoma diagnosis, so I don’t know if what hormone related or just that was a bad time for me and my skin? I had those removed that changed enough that pictures looked different. I think I had maybe 4 taken off in my entire pregnancy with Alex and 1 was severe (done like the insitu) and the rest were atypical but nothing needed re-excised. I had a few keratosis things removed too, on my chest. I got most of my changes in the end, and it was mostly the small moles on my belly got darker, but I got a really dark line too, unusual for a blond/fair women I think. I removed a stomach mole that got slightly bigger and darker after Alex was born and it was mild to mod atypia. So, in the end, I suggest if you get pregnant watch for change, as you do, and if it is significant change then remove it. They can do it all while pregnant. SINCE having Alex, and after 3 yrs have gone by, my skin seems to be more stable, although maybe this twin pregnancy will change that :) I will keep you all up to date!

    Best

    Jenni

    #60507
    BigRed1984
    Participant

    Oh no Toastwave! I would be very frustrated. But I think I would go with 1. and do a conservative re-excision to get the margins. Unless you felt the mole was especially concerning. But if It looks like the others I would re-excise and hope for the best.

    DKo6, to answer your question my moles changed some but not alarmingly during pregnancy last time. I developed several new moles, and some of my old ones got darker and some larger. I think they got larger because they were in areas where my skin stretched a lot. I am currently 22 weeks pregnant with #2 and there are no significant changes so far, I am sure most of my changes occured late in the pregnancy last time.

    Toastwave, I am very excited for you and your growing family. I hope you will post when you have the baby and fill us in on the details.

    Jenni, I am excited for you as well. I hope you are out of the nausea soon!

    Have a beautfiul day! :D

    #60508
    toastwave
    Participant

    Hi all,

    Thank you for your opinions. My partner and I talked about it and I think we will do the re-excition after the baby comes to minimize scarring since it is likely that it was just mild to moderately atypical. I think the challenging part will be to be at peace with the decision and then put it behind me. Nothing in life is 100% guaranteed anyway. The hecticness of a new baby and a toddler should significantly help with the forgetting about it for a while anyway. I have three other moderates that need to be re-excised and we are waiting for August on all of them, again becuase of increased bruising and gnarly scarring.

    As for pregnancy changes, my skin is a mess! This happened with my first as well…I definitely get that dark line up my belly and just kind of darker spots throughout (thankfully not my face) so the whole thing morphs. I was not on the lookout for mole changes last time around except for the new random mole that sprung up, which was the one that set me on this fun course. So, I cannot compare this pregnancy to that one but some of my moles have definitely changed this pregnancy.

    My moles are very small but they generally conform to 3 color patterns- dark brown, light brown with some slightly darker brown specks, and just light brown. So, I watch for change. This pregnancy, I’ve had a very dark black raised mole (not typical for me) that popped up under my arm. It looked like my original mole so we biopsied it. It was one of the moderates. I also had a mole on the back of my leg start changin rapidly (as in twice the size, scalloping, and darkening) within two weeks so that one was biopsied as well. It ended up being severely atypical and I had a WLE during the second or third month of pregnancy (now I cannot quite remember). Then I’ve had two other develop black spots in the middle that were not there before. One was a moderate, one was a mild, and the third is the missing mole. I would say that my skin is definitely less stable but also that, because I am pregnant, the dermatologists are being a bit trigger happy…they, not I, have suggested the biopsies though I pointed out the change.

    Anyway, I will be getting photographs once the hormones settle down post-pregnancy and hopefully use those for ever after, which I hope will cut down on the biopsies. Though we have toyed with the idea of 3 kids, I am pretty certain this second one will be the last one that I have myself. I know there is no correlation proven, etc, but we will feel extremely fortunate to walk away with two healthy (hopefully!) kids and 2 years NED on July 11th. We just don’t think that we want to tempt fate…totally supersticious, I am sure :).

    Hope the morning sickness has abated, Jenni. Gosh, twins, good luck! How cool and frightening :).

    #60509
    cohanja
    Participant

    for mild atypia, many times they don’t re-excise anyway….

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