Hi, I am a 34 year old woman and have a small, flat lump on my shoulder. The lump is under the skin and the only reason I originally noticed it is the slight pink color on the skin surface. I have had the lump for a while, it is not painful and hasn't changed. However, I was concerned about it and asked my general practitioner to look at it during my annual physical a few months ago. He said it was probably an Actinic Keratosis and gave me a topical cream (efudex). So, I used the cream and it was successful in eating away a few layers of skin and making the area look sore and much worse, but I can still feel the lump. My doctor doesn't seem concerned and said he doesn't think it has the characteristics of melanoma. I have been searching the internet and don't think it's an Actinic Keratosis and was terrified to learn that melanoma lumps/nodules are frequently mis-diagnosed and they are one of the most aggressive cancers. My question is, does a general practitioner know enough to make the determination that it's not melanoma? Should I still be concerned or should I get a second opinion? I do have an appointment with a dermatologist (that I have seen in the past) for a full body exam, but he can't see me until September, I'm afraid if it's cancer I could be dead by then -- okay I can also be a bit of a hypochondriac :). I appreciate your opinion and thoughts. Thanks!
Actinic keratoses generally don't appear on the shoulder, and they aren't lumps. I think you need to see a skin doctor. I do not think what you describe sounds anything like melanoma. Melanomas are almost always black and on top of the skin. If you're that worried, call and yell that it's an emergency. Yelling helps.
A general practitioner would be able to identify melanoma. It is quite distinct in its appearance. In addition it would start superficially (since thats where melanocytes are located) and have a hyper or hypo pigmented lesion.
Have you considered that the lump might just be a lipoma?
Now that so many dermatologists devote huge (and profitable!) chunks of their practices to what I think of as "spa" treatments (facials, dermabrasion, chemical peels, botox, etc.), it's no big shock that's it's harder than ever to secure an appointment with them.
Recently, our son developed alopecia areata. I called the dermatologist I've always used--and who has always been quick to see any of us before--but now that he's gone "spa," the earliest appointment they would deign to give me was months out. Needless to say, I fired him. (Too bad he'll never even notice, huh? <grin>) Called the local Children's Hospital for recommendations, ended up with a lovely new dermatologist who treated our son not only quickly (within days, not months), but also effectively and with great sensitivity. Her practice does some spa stuff, too (such as selling all sorts of skin products a person could get in any health food store of reasonable size, and for far less money), but has apparently not yet lost touch with her inner scientist and clinician.
Anyway, I find the "spa medicine" phenomenon fascinating. Around here, the "holistic" center is really taking off--often, these combine chiropracters, dermatologists, acupuncturists, massage therapists, aromatherapists, hypnotists, excercise therapists etc. Blurs the line between medicine and non-traditional health practices in interesting ways.
I agree that 7 months seems like a long time to wait, but this particular Dermatologist is one of the best in the area and he always has a 4-8 month wait for appointments. He will see me earlier with a script from my GP that says it's medically necessary, but my GP doesn't think it's a skin emergency. My concern is, if he mis-diagnosed it as a AK, then who's to say he is wrong about it being melanoma.
I appreciate that the Dr. here said he doesn't think it sounds like melenoma either, but I'm still worried about nodular melanoma, it didn't sound to me from the internet sites that they are always black.
Maybe I'll call and see if the Derm can put me on the cancellation list.
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