Premalignant melanoma

I had a suspicious mole in between my breasts removed and the biopsy came back as premalignant.  My doctor then removed more skin around and below the site to see if all premalignant cells would be removed.  That report came back as margins clear on sides, but depth still showed some premalignant cells.  He says safe thing is to remove more deeper and see again.  Or he says I could just watch it and see.  This is my family practice specialist who is doing all of this.  He is skilled in this area from what I understand. I trust him and he's talking to specialists to see what his next move is.  But some questions I have are: what is the likelihood of these now 'under my skin premalignant cells' turning into melanoma and spreading?  Should I go now and see a dermatologist?  Are they better qualified to remove deeper tissue?  Should I ask for results of the reports?  I haven't actually seen them.  I am kind of worried about all this and just need a second opinion about what to do.  Thank you for your help.  

[Fernando Roque, MD]

Hi.  Can you give the exact words of the biopsy report? There are various types of pre-malignant skin conditions which have varying potential for turning into frank malignancy.  I think I can answer your questions better if you can provide this information. Thanks and hope to hear from you soon.

[trisha7777]

Hi, Dr. Roque.  Thank you for helping.  I got the results faxed to me.  They state...1st diagnosis of original mole is intradermal melanocytic nevus of the skin (extending to margins of the biopsy).  2nd diagnosis of re-exision states....intradermal nevus.  no atypia present.  The deep surgical margin of resection is involved.  Doctor further notes, there are no atypical cells present but the pathologist states that there is some involvement in the deep margins - will need to watch for any recurrence as to whether further procedures are needed.  My doctor recommended to be on safe side to go deeper.  Have appt. on 3/14.  Thank you for your opinion.  I really appreciate it.  

[Fernando Roque, MD]

Hi.  What is not clear to me is if your original biopsy yielded atypical cells.  Melanocytic nevi only have the potential for developing into melanoma later on if they are "atypical moles" (moles which contain atypical cells).  Assuming that the original biopsy of that nevus did contain atypical cells, you have a risk of developing melanoma between 30- 46 times greater than the general population.  The risk further increases if you've had a previous history of melanoma or if you have a close relative who has been diagnosed with melanoma. So one question you should ask your doctor is: do any of your biopsy results show atypical cells?

Hope this helps.

[trisha7777]

Let's assume they were atypical, which I think they were since they indicated premalignant and have the potential....that risk you indicate between 30-46 times greater...is that in the spot if not all removed, or just anywhere in general?  If they get all atypical cells, is there still a risk that much greater?

Thanks again!

[Fernando Roque, MD]

Hi. The increased risk refers to the atypical mole developing into malignant melanoma later on.  The risk doesn't pertain to areas of the skin which do not have any lesions.  Assuming that the mole was totally removed, with no residual atypia even in the deep margins, then the risk of developing melanoma is reduced.

[trisha7777]

Thank you, Doctor.  I have an appt. for doc to go even deeper in mid-March.  If they feel that all the atypical cells were removed, my risk is reduced...do you know what percentage the risk is if ALL is removed?  Also, what if they go deeper and still feel they didn't get it all...that would be third time.  What do you recommend as the next step?  I'm sorry for the 20 questions and I really appreciate your help.

[Fernando Roque, MD]

Hi.  If the atypical mole was removed entirely, then you would not have any risk of recurrence or cancer development from that mole.  However, if you have had a previous history of melanoma, or if you have a strong family history of melanoma, your risk probably isn't only coming from the mole that was excised.  Having a previous history or family history of melanoma increases your baseline risk of having the disease, whether or not you have any moles present.

If your doctors don't find anything on re-biopsy, the next step probably would be to simply  follow up with your doctor intermittently for surveillance, and particularly if a new skin lesion appears.

[trisha7777]

Dr., I really appreciate all your help.  This is a great forum!  I do not have any previous or family history of it.  I only had that one mole...my whole life, I think.  Could it have been premalignant for a while or from start?  I have suntanned a great deal in the past but it is in a spot that the sun does not shine much.  I am not convinced that it is from sun tanning, althoug, I know that's not good for you.  Again, I appreciate your help and I hope you have a wonderful day!!  God bless you doctors!