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Old 06-18-2011, 04:36 AM   #1
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Help figuring this out

Hi Everyone,

I was just wondering if anyone had any ideas on this. I had a punch excision on a mole that was on my left shoulder.

Diagnosis came back as Lentiginous junctional nevus with architectural disorder and severe cytologic atypia, extending to one lateral margin.

Now, I think that sounds way scarier than it actually is as the dermatologist said that at this point it is only pre-cancerous and she is sending me to an oncologist surgeon to do a complete removal soon.

Then, I read her comments, and another doctor who had reviewed her work.

It said alot of medical jargon, but this had me wondering---"Although the findings fall short of an outright diagnosis of melanoma in situ, the degree of pagetoid upward scatter and atypia are concerning for a significant precursor legion."

Does this mean it could be cancerous underneath the skin? If so, has anyone had a punch excision, then found out after the full excision that the rest of the mole was cancerous?

I am not too worried as I am lucky for the pre-cancerous diagnosis. Just curious as to the whole process, surgery, more findings, etc.

Thanks to all of you for reading this!


 
Old 06-18-2011, 08:30 AM   #2
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Re: Help figuring this out

I'm not familiar with the punch procedure but from what your saying and what you read..it sounds like she is being cautious to make sure there is nothing under the mole. I've had several taken off by being frozen off and also 2 on my face that needed surgery.

The last one I had taken off by the Moh's method. The Dr. explained to me that they remove one layer and then have you wait about 45 minutes for the results to make sure there is nothing beneath. Once they know they have gotten it all you then get stitched up. Luckily mine was all taken with the first layer.

Hope this helped...JJ...
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Old 06-19-2011, 04:00 AM   #3
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Re: Help figuring this out

Hi, thanks so much for your response! The punch excision is just another way to say that they only did a half excision on the mole instead of the full removal, atleast that's the way I understood it.

I agree with you that they are probably being cautious on taking the rest out. It's nice when someone else gets the same take on something--makes me feel better. Thanks!!!


 
Old 06-19-2011, 06:19 AM   #4
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Re: Help figuring this out

Ok..I think I get you now. When the Dermo guy did mine he just took a sample, probably exactly what you had. Then he sent it off to a lab and I got the results in about 5 days. That particular one was cancerous so I had to have it surgically removed. They pretty much can tell when they are cancerous or not but this particular one just looked "suspicious" to him, even though it only looked like a patch of dried skin.

Even though it needed surgery I'm glad it was done and didn't spread. Now I am very cautious if I see anything unusual. 3 months ago a mole showed up near my right ear out of nowhere so I called. Luckily it was nothing that couldn't be frozen off...WHEW!! I'd rather have them be more cautious as my old Dr. left a mole on my forehead go for way too long so that needed surgery too. Had it been tested earlier the Dr. said it probably would have easily been taken off.

Good luck and keep us posted....JJ...
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Old 06-19-2011, 01:29 PM   #5
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Re: Help figuring this out

I am sorry you've had to have so many procedures and surgeries.

I have had 5 moles taken off in the past, but this is the first one with the pre-cancerous issue. I know it could be much worse, so I am grateful that it is not.

Let me ask, though, how deep and wide do they go when they do the complete removal?
I have quite a few scars (especially one on my neck from a surgery that I hate) so I just wonder what this one will look like.

Thanks for all your help!

 
Old 06-19-2011, 05:13 PM   #6
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Re: Help figuring this out

Well it all started about 2 years ago when I had a round white lump in my throat that my old Dr. swore he didn't see......I could see it with a mirror, so go figure. I researched my problem online for 3 days till I actually saw a picture that if I didn't know better would swear it was of my throat. It was a cyst on the Epiglottis gland. I asked my GI Dr. who I love and trust for a referral to a good ENT and when I went I explained why I was there and what I thought I had. He was shocked as he said he never in all his 30 some odd years heard of an adult being able to see it. He scoped me anyway and was amazed I did such good research. At that time I also showed him a mole over my left eye which my old Dr. said was nothing, but this Dr. said.."Oh yes it is something, it is a cancerous mole". When I went in for my throat surgery 5 days later he also removed the mole, and yes, I had a fairly nasty scar for about 4 months. He in turn set me up with a good Dermo guy. Needless to say I no longer have that old Dr.

At my yearly visit last year the Dermo discovered the scaly patch on my forehead right at the hairline and did a biopsy. That came back as cancerous as well, so seeing the skin is so thin in that area I had the Moh's method to have it removed. All they told me was they took one layer of skin off and got it all. With that method you wait 45 minutes for them to make sure they got it all and then they stitch you up. I was nosey and looked in the mirror......I swear it looked like I had a small bullet hole in my head. After they stitched it etc. it was obviously red and noticeable but within about 6 months you could barely see it. Like I told my Dermo guy...leave it to me to have the bad ones on my face and all the non cancerous ones elsewhere, but hey, they are gone and I now keep a very close eye on anything weird looking.

To be honest..you can barely even see anything today from either of them. All I know is both were one layer of skin deep and about 3/4" long but neither were wide. Both were noticeable for about 3-6 months after the surgeries mostly due to the redness and being in such sensative areas, but now, nothing. The one on my forehead in a good light looks like just a very thin line. Both Drs. did an excellent job.

Wishing you the best...JJ....
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Last edited by JJ; 06-19-2011 at 05:14 PM.

 
Old 06-20-2011, 01:52 AM   #7
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Re: Help figuring this out

Thank goodness you were able to see the cyst in your neck! It is pretty amazing how you were able to see it when the doctor didn't. Pretty scary, though.

I think I will be getting a call from the new doctor's office sometime this week--the dermo said he was an oncologist surgeon. Hopefully, they'll schedule something soon for me.

Once again, thanks for all your help!

 
Old 06-20-2011, 06:23 AM   #8
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Re: Help figuring this out

Well I'll be honest..how he claims he didn't see it is above and beyond me and my new Drs. Only reason the ENT scoped me was to make sure it wasn't attached anywhere else. It was the size of a small white marble. Luckily it wasn't cancerous.

Hope you hear something soon and definately keep me posted. Best of luck and well wishes...JJ....
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Old 06-20-2011, 10:37 AM   #9
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Re: Help figuring this out

There are normally two ways of taking a biopsy from a mole: punch and shave. Punch is the better option. A shave biopsy is done exactly as it sounds: the doctor shaves off the top layer of the mole. A punch biopsy is like a tiny cookie cutter - the doctor "punches" through the mole and removes an actual piece of skin. Depending on the size of the mole and its location, stitches may be involves. I've had 4 shave biopsies and 3 punch biopsies. 3 of the shave biopsies had to be cauterized (they were extremely large moles), and left bad scarring. All 3 of the punch biopsies required stitches. My melanoma diagnosis came from a shave biopsy.

Doctors usually prefer a punch biopsy because it removes the entire mole in most cases. If your melanoma is in situ, and your doctor performed a punch biopsy, chances are all of the cancerous tissue was removed with the biopsy. A wide excision is done as a precaution and to insure clear margins.

 
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Old 06-28-2011, 01:40 AM   #10
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Re: Help figuring this out

I know she definitely said Punch excision--I did get the stitches, they removed them two weeks after.

Now I have an appt with that oncologist surgeon next week for a consultation.

Thanks for responding and for your explanations of the punch and shave excisions, that helped alot!!


Last edited by eddysmom1; 06-28-2011 at 01:53 AM.

 
Old 07-17-2011, 05:52 AM   #11
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Re: Help figuring this out

Well, I had the appointment with the oncologist surgeon. I am having the surgery on Tuesday. He said I have a bit of a chance of cancer in the underlying tissue. He did say that if there is, he feels that it will be localized because of catching it early.

So, on Tuesday it is. Just updating you all and thanking everyone again for their support.


 
Old 07-19-2011, 07:46 AM   #12
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Re: Help figuring this out

Just saw this today - Tuesday. Hope all went well, and sending many good wishes your way!! Please let us know how the surgery went!!

 
Old 07-20-2011, 04:27 AM   #13
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Re: Help figuring this out

Hi! The surgery was ok--hour and a half under anesthesia--I was a little surprised it took that long. I thought it would only be a half hour or something. I have the post-op appt with the oncologist on August 3rd. I am sure he will tell me everything is fine, now.
I am staying home from work today because I am going to take some of the Vicodin they gave me (hurts a bit) and I don't want to be driving on it.

Thanks so much for the support and good thoughts and wishes!

 
Old 07-20-2011, 04:16 PM   #14
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Re: Help figuring this out

Glad to hear everythings seems to have gone well. Sorry to hear about the pain, but hopefully that will be gone soon. Looking forward to hearing you get a complete clean bill of health come 8/3!!

 
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Old 07-21-2011, 03:50 AM   #15
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Re: Help figuring this out

Thankyou! It's been nice having someone to talk to who has gone through the same thing.

 
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