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  • 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

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    Old 08-30-2004, 08:43 PM   #1
    kippy6
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    11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi. My 11 year old daughter had a dark mole on the top of her Big toe. I asked that it be taken off a couple of weeks ago. (I had read that moles on toes are at risk for melanoma.) The dermatologist's office called a few days ago to say that the report came back - her mole was moderately/severely abnormal. They gave me names of pediatric plastic surgeons to see, as they said they did not get clear margins, and the plastic surgeon would have to cut deeper and wider until they got clear margins.

    I have 2 questions:

    1. What can I expect as to the extent of the surgery from pediatric plastic surgeon? Since it is not melanoma yet, I do not expect them to amputate her toe. However, will they cut a few millimeters or centimeters in this situation?

    2. Is it crazy to ask that she go ahead and have blood tests, and any other preliminary tests (as if she already had melanoma) to make sure she does not have melanoma in her system from other moles that could possibly be misdiagnosed, and not biopsied? What if one of her other many moles is melanoma, and we don't biopsy it because it "looks normal?" She has so many moles on her body (scalp too).

    Before biopsy, the mole on her toe looked fine. It was symmetrical, only one color, not a big mole, but it was a dark mole. The dermatologist did not think it would turn out to abnormal in any way, and told me it looked fine (it did look like a normal mole). I had to go back a second time to request to have it removed (I was concerned b/c of what I had read). So my worry is that what if some of her other moles are already melanoma, and the doctor doesn't biopsy them since they don't "look" abnormal. What if she already has melanoma??

    I also noticed yesterday that she has a skin tag on her neck. It is tiny in diameter, but long, and protrudes from her neck, with a dark spot on the end. This is the first time she's ever had a skin tag. Also, the inside of her foot has started to hurt, and she cannot remember hurting it. I've looked at it, and it appears to be swollen just a bit in one area. This is the same foot where the mole on big toe was removed.

    Your response would be most appreciated.
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    Last edited by kippy6; 08-30-2004 at 08:55 PM.

     
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    Old 08-31-2004, 09:21 AM   #2
    Belle2003
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeo

    There are several different types of skin cancer and only melanoma is the dangerous one. Did the biopsy say it would have developed into melanoma?

    If your daughter has a lot of moles, of course you can't start taking them all off, but I would monitor them and have her get them checked once a year or more. If you haven't already had a mole check done on her by the dermatologist you should schedule an appointment. I know when I have had a suspicious mole, the dermatologist suggested measuring it and seeing if it changed size or appearance. You can do this too with your daughter. I believe they call this mapping.

    When she goes to the plastic surgeon they wil probably just take a small scoop of skin out where the mole was and then stitch it up. To be on the safe side they take a little extra when it is not on the face.

    Since she has a lot of moles you should teach her to stay out of the direct sun during the peak hours as to protect her skin from further harm.

    I do not know if they have blood tests that determine if you have melanoma. I believe they can only tell from a biopsy. Someone will correct me if I am wrong.

     
    Old 09-01-2004, 03:35 AM   #3
    BonBe
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    You are right Belle

    I myself am faced with surgery TODAY to remove a malignant melanoma which was found ONLY from a big biopsy and as soon as they found out it is melanoma next thing you know before I could blink my eyes, I am having surgery to remove a small orange size area of my back (up by my neck) this afternoon, and then in 6 days I begin cancer treatments at a major cancer hospital here in Toronto (candada)

    A innocent mole we all thought doctors included. Only thing it was black and ugly and not considered at all to fit 'in the textbook' description. Boy were we all fooled. Only a true biopsy (and they did it twice to make sure, as this whole thing came right out of 'left field' as that saying goes.

    I am 54 have never been a sun worshipper, in fact I cover up, slather on stuff and sit in shaded areas (we go camping each summer) I do not tan well, I burn if too much sun, been burned say only 3 times in my whole life, two when I was a child and one a few years ago.

    I never have before realized just how important life is to us. Now facing this! but I am just praying and have a great support group with my Church family, my family family, and oodles of friends all chanting our 'mantra sort of" Pray they get it all....I just keep saying this.

    So to the mother of the 11 year old, yes by all means get any mole that looks like it may be suspicious checked, and like Belle said avoid the sun at all cost.

    My cancer I cannot believe is from sun, but no family history, at all for skin cancers of any kind...male cancers run through but that should have no connection.

    Bonnie

     
    Old 09-01-2004, 07:46 AM   #4
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi Kippy! I too am covered in very abonormal moles. I have had 3 removed, one on my back was over an inch in diameter and very dark. (Melanomas are most common on the neck and trunk) It went so deep into my skin (about an inch) that they actually had to cut it out and stitch me up. The biopsy came back as a "confined juvenile melanoma" Benign at the time, but the type that will often become cancer. I do have a pretty noticeable scar there because mine was done by a derm and not a plastic surgeon, but I scar easily anyway. I had one from my stomach with the same diagnosis, and another from my back that was a "benign spitz nevi" very abnormal, but benign. If you do a net search on Spitz nevi (named for the woman who researched abnormal childhood moles), you will find that some people from childhood are genetically predispositioned to be covered in abnormal moles.

    I check my moles constantly. I have to because I'm covered in them. The derm says I have a slightly higher risk of developing melanoma because of the ammount of atypical moles I have (irregular coloring, borders, size, etc) but the fact that these types of moles are genetic and I have no family history of melanoma is a really good sign. Skin cancer is very rare in children.

    Cal is 14 months now and he's had a dark freckle in his butt crack I first noticed at 6 or 7 months. My mom says that's how the huge mole on my back started in infancy, so I'm praying that Cal doesn't develop one there!!!
    I can only imagine the problems that could cause!

    Anyway, I don't really think I've answered any of your questions, but maybe sharing some of my experience will help you some! Good luck and keep us posted.
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    Last edited by siren1024; 09-01-2004 at 07:50 AM.

     
    Old 09-03-2004, 09:12 AM   #5
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi all. Thanks so much for your replies. Hello to you too Siren! I remember talking to you on the Pregnancy Board. I hope all is well with your family! Bonnie, I will say a prayer for you and your family. That is most unusual to find melanoma on the 2nd biopsy, when the first one did not show melanoma. I am thinking of you. Please let us know how it all goes.

    The dermatologist's office had told us when they called that the next stage would be melanoma for my daughter, so we needed to see the PPS (pediatric plastic surgeon) in order for him to remove more of her toe area since the derm. did not get clear margins.

    The original mole was located on the "dorsal right Great toe." Which means, right foot, and on the top of her BIG toe, below the toenail. (it's not located in her nail bed area at all, it's just under her toenail area...between the toenail and the knuckle.)

    So we visited with the PPS yesterday. He drew a picture physically on her toe of how much he would cut out. This is only going to be twice the diameter of a pencil eraser. He then said he would use general anesthesia in order to do this. He said that if injects an anesthetic into the toe, that he doesn't know how many times he'll have to inject, as my DD could say that it still hurts. He says that if he has to inject too many times that the toe could turn black and die. I have never heard of this before!

    Please help, as I've tried to research online, but I can't find ANYTHING about someone's toe dying from injections of numbing medication .

    Last edited by kippy6; 09-03-2004 at 09:20 AM.

     
    Old 09-03-2004, 11:52 AM   #6
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hello Kippy

    Know that you are doing the best for your child that is key. I am not aware of toes turning bad after many injections, but it may be true, considering the size of the toe.

    I had better clarify. I had a normal biopsy done on a totally unsuspicious mole only thing it was HUGE and black and had reddish circle. Did not fit any 'textbook' criteria, nor did my family or personal history.

    When I said a second biopsy, I meant that the two doctors had the lab go over the tests as they could not believe the diagnosis. One biospy, had 5 injections but it is a larger area than your dear girl's toe, so that would not be a factor me thinks.

    When it was 100% sure it was malignant melanoma, this latest surgery was done. I see the surgeon this coming Tuesday, and on the same day in the afternoon I head to the "special hopsital' where they will determine the course of treatments to follow.

    Moles on toes are not common are they? neither is where mine was. And I know if I could have seen it (the mole) front and centre, I would long ago been to see about it, but like I said it was just a ugly thing. My DD took a digital picture of it, before and after....and comparing it to all the many many photos just on the internet of various types of moles, good and bad, it did not look like anything so it hit us all for a loop.

    dx'd on the 24th this surgery on the 1st cancer hospital on the 7th all so fast for my slow thyroid self to manage, but we all do manage. I think you are doing the best you can for your daughter, and I am glad you caught it early in its stage.

    Love Bonnie

     
    Old 09-03-2004, 12:55 PM   #7
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Bonnie - I read that you had surgery on Sept. 1st, and that you will be going to cancer hospital the 7th. Do you know what they will do at the cancer hospital? Will you get chemo or radiation? I hope that you will recover well from your current surgery, and that you will be pain-free very soon.

    Siren - I wanted to tell you that when my brother was born, I was 6 years old. He was born with a very large mole on his back. It practically covered his whole back. It wasn't cancerous, but they wanted to remove it b/c of the potential to become cancerous. If I remember correctly, they removed it when he was 6-12 months old. At that time the mole was the size of a dinner plate. His scar is still that big, even with using a skin graft from his leg. So I wonder if that is genetic, and that it might increase my daughter's chances of getting melanoma.

     
    Old 09-03-2004, 03:21 PM   #8
    Belle2003
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeo

    I wouldn't worry about the doctor having to inject her toe too many times. I found myself in the emergency room with a nasty deep, long cut, all the way down to the bed of the toenail on the toe next to my big toe. The emergency room doctor put in one shot and then had to take a q-tip to clean out the cut in search of glass and then stitch it up. Just that one shot and I never felt a thing. (And I can be a big sissy) I am sure that your daughter will only need a shot or two. The toe is so small, it should not take a lot of shots to numb it up.

    I think the plastic surgeon is just being responsible in letting you know of all of the risks. Now a days they have a legal responsibility to do that. Just like those television commercials advertisng medications. They tell all of the possible side affects. After listening to them, you would never want to take the medication.

     
    Old 09-05-2004, 09:14 PM   #9
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi Belle - Thanks for your response. I'm glad to know that you only needed one shot. Well, I saw the lab report for the first time the day we took my DD to the pediatric plastic surgeon (PPS). The derm. office had faxed a copy of the lab report to the PPS. As it turns out, the nurse from the derm. office had hand-written on the report that my DD needed to see a doctor who specialized in MOHS.

    Later, I remembered the PPS asking me during the appt., "why does this report say MOHS?" and I replied that I didn't know. So Friday, I called the derm. to ask why MOHS was written on the lab report. She told me it is because we need to see a doctor who specializes in MOHS. I told her that her office didn't mention anything abou MOHS to me, and only gave me the name of a PPS, and this guy did not specialize in MOHS. So now we are starting over again finding a doctor. It makes me kind of mad though...I had to check my daughter out of school, missing important classes, and my husband missed time at work all so we could go to that appt. with the PPS. The derm. office should have mentioned this MOHS thing to me in the first place....

    As it turns out, it looks like doctors specializing in MOHS do not use general anesthesia. That is good for us, since we did not want DD sedated.

    Last edited by kippy6; 09-05-2004 at 09:15 PM.

     
    Old 09-10-2004, 08:04 PM   #10
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi guys. Just wanted to let you know that we dumped the plastic surgeon idea. He wasn't going to do a skin graft or anything after all. We do not find it necessary for our daughter to be put to sleep for a spot on her toe.

    So we found a Dermatologist specializing in "Mohs." He is actually going to perfom the "Slow Mohs," where he takes off one layer of the top of her toe on day one. The results from the biopsy come back the very next day. If it does not show clear margins, then we go back on Day 2 and have another layer removed. We keep doing this day after day, until the biopsy reports show clear margins. I am much more comfortable with this plan. We will be doing this in 2 more weeks.

    By the way, have any of you heard of mole mapping? I looked it up, and it sounds interesting. The research seems to indicate that it reduces the # of biopsies a person has each year.

    Last edited by kippy6; 09-10-2004 at 08:07 PM.

     
    Old 09-11-2004, 10:06 PM   #11
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    That's good that you've found something you're comfortable with.

    What is mole mapping? It may be worth knowing for me. I've had 4 biopsies in 3 years.
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    Old 09-13-2004, 03:41 AM   #12
    kippy6
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi Siren,

    Mole mapping is where they track your moles, I believe by taking pictures. Since I can't list websites on here, you could look up the info here on Healthboards. Try searching for "mole mapping ?'s" originally posted by "moley" on 11-17-2003. I don't really know much about it, but this thread lists more info on it. Hopefully insurance will pay more frequently now.

    Kippy

     
    Old 09-23-2004, 06:44 AM   #13
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    Re: 11 yr old DD had biopsy of mole on top of her BIG toe. Referred to plastic surgeon.

    Hi guys - just wanted to let you know we ended up using a dermatological surgeon (who specializes in MOHS) to remove our daughters abnormalcy on her toe. She has quite a large gauge hole on the top of her toe, but I'm hoping it will fill in as she heals. Because of her age, we did the SLOW MOHS route. They called us back the next day and told us that they got clear margins and we did not have to come back in to get more of the area removed. We were very pleased. Her toe bled a lot though after the surgery. I'm just glad to have this over with.

    I told him what the PS said about putting my daughter asleep for the surgery, and the dermatologist said that was a riduculous idea!! I'm so glad we opted to find another physician who could remove the precancerous area.

    Now we just need to take her back to the dermatologist to have him look at other areas on her skin. Would you guys recommend a specialist? What kind of specialist? Our regular dermatologist is not real thorough, and I had to insist that he remove the mole off my daughter's toe to begin with. I'm just wondering if there is such a thing as a dermatologist who SPECIALIZES in recognizing skin cancers, as well as taking the biopsy. I want someone to take a little longer than 30 seconds to look at the 35+ moles on her body. Shouldn't some be looked at with high magnification? I'll probably post this question on a separate thread.

    Thanks!

     
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