Change to atypical mole...

[mrcjschu]

Hello,

I have a mole on my upper right arm that is undoubtedly atypical.  It is not terribly atypical, but does have slightly blurry borders and a mix of two shades of brown.  I have full body photography that helps me keep track of my moles as I have hundreds!  I do have a history of a melanoma in-situ in 9/04 on my upper left arm, and have had numerous biopsies since then, but none have been worse than moderate atypia.

Since the photographs were taken in 2004, there has been virtually no change.  I even have a photograph (snapshot) taken July 9 that shows a still stable mole (different lighting, but I can tell).  On July 13, I noticed that I had developed a "bump" at one end of the mole.  Of course, I picked at it, and was left with a scab that seems to be healing and is going back to normal.  It is still more red than usual, but I assume that is from the irritation of my picking and prodding.  

So my question is, can a pimple develop within a mole?  Or - since I also have keratosis pilaris all over my upper arms, could that have affected the mole with a bump within this mole?  I have the typical red rash appearance, but also occasionally get the more pronounced bumps as well.  I have scheduled an interim appointment with my dermatologist for next Wednesday, but my fear is that this mole has suddenly developed a mind of its own and I have inadvertently picked off an advanced melanoma.  I am regularly screened every four months by my dermatologist due to my history, and I perform self-exams every six weeks using my photographs.

Simply to calm my fears, can you tell me if an advanced melanoma can form that quickly?  And if I did pick it off, would it be healing normally, or would the bumpiness be on the way back already?

Sorry for all the questions and ramblings - but I am, as always, on the lookout for new or changing lesions as I want to stay on top of my skin.

Best wishes and thanks in advance for your assistance,

Becca.

[Alan Rockoff, MD]

rapid changes signify trauma, not melanoma.  Yes, you can get a pimple on a mole.  That all the biopsies show only moderate atypia is reassuring.  best to leave the mole alone till Wednesday so the dermatologist can make a good judgment.  Multiple melanomas are very rare.  Four-month surveillance seems adequate.

Best.

Dr. Rockoff

[mrcjschu]

...one other question.

While I fully understand the importance of a lifetime of vigilance, how common are multiple melanoma primary tumors?  I have many, many moles, but only a handful look atypical.  My derm has told me that based on number alone I would be considered a candidate for DNS, however - he feels it's more of an atypical mole pattern because so few of them are larger than 3 to 4 mm and nearly all are completely ordinary looking moles.

Just a question as to what you've seen in your experience with melanoma patients...

Thanks!