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Old 11-06-2011, 05:20 PM   #1
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Severe atypia...melanoma.

Hi all! I've recently had a number of moles removed and I'm really concerned about the results.

I had 2 moles removed in Aug and one came back with a report of severe atypia. My Dr did a re-excision of the area and removed two more suspicious moles at the same time. One was an 8mm mole on my chest. I received a copy of the pathology report and I'm confused and concerned. It says:

"At least compound dysplastic nevus with regression and severe atypia extending to the peripheral specimen edges. Both cytologic and architechtural atypia are highly concerning in this lesion to the point that melanoma was considered in the differential diagnosis. Though the features in this biopsy fall just short of a difinitive melanoma, definitive treatment to ensure complete removal of this lesion is recommended."

The result of the 2nd mole removed that day was reported as " HMB45 immunohistochemical stain shows appropriate loss of stainging in nevus cells with descent into the dermis."

I have since had a re-excision on both areas (this past Friday) and had an additional 3 moles removed. I should have the pathology results within the week and I'm praying for positive results. So far I've had 3 atypical moles out of 4. 3 more to go.

I guess my question is this: If a melanoma diagnosis was considered, why was it thrown out? Is melanoma that irregular that it can be an iffy diagnosis?

I'm just scared. I've never been afriad of my own skin before and these results are just a little too close for comfort. Thanks in advance for any advice...

 
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Old 11-07-2011, 10:25 AM   #2
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Re: Severe atypia...melanoma.

Hello! I certainly know how that one word - "melanoma" - can alter one's whole life. I was told I had malignant melanoma in February 2007, and the idea of being "afraid of one's skin" is a perfect way of thinking about it. I can so sympathize with where you are at right now.

The problem sometimes with reading pathological reports is understanding the terminology. It is, indeed, an entirely different language! This phrase is important, "that melanoma was considered in the differential diagnosis." And the operative term "differential diagnosis" is key.

Let me see if I can explain this. If you go to the doctor with a list of symptoms, the doctor will attempt to diagnose what the problem is. However, sometimes those symptoms my closely resemble other illnesses. The flu might be something more serious, such as Strep Throat. So, a doctor might perform a "differential diagnosis." S/He would begin with a more common illness (flu), perform tests or biopsies, and see if it might be narrowed down from there (Strep, if it exists).

I imagine what your doctor did was give an original possible diagnosis of melanoma, and when the pathologist looked at the biopsy, s/he stated there was no melanoma. However, the mole (nevis) was atypical (this is not something to panic about, almost everyone has at least one atypical mole), and recommended further excision.

Now, there are differing opinions regarding atypical moles. Melanoma sometimes develops from atypical moles, but not always. (Mine did not) So, some doctors will always do a wide excision on atypical moles. Other doctors will prefer to take a "watch and see" approach. Neither is right or wrong, and it really comes down to a patient's comfort level.

If you feel your doctor is providing you with the level of care that you are comfortable with, than that is right for you. If you are unsure, you can always get a another opinion. It's your health, it's your body, and a doctor's word is never final when it comes to your comfort level.

From what I read, I think your level of care is good and I would be secure in the care received. BUT, it's not my body. I am not you. I can only give you my very, very uneducated opinion. My advice? Educate yourself and try to talk to as many people as you can. Be open with your doctor and never, ever be afraid to question! Do not leave the doctor's office unless and until you are absolutely comfortable that you understand everything that was discussed with you.

The fear that you speak of is completely normal. It has been 4 years for me, almost 5, and while there are times melanoma is not always first in my mind, the 3" scar on my right knee reminds every morning and every evening of where I've been. And where I might go. BUT, it also makes me very thankful for every single day in my life and every single person in my life. It's hard, but don't dwell on the "what ifs." Dwell on the "what can be's!"

 
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