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Dermatology (Expert Forum)
Pathology question...
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
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Pathology question...
by TDBC, Jun 11, 2009 06:52PM
I just had a few "suspicious" areas removed. Two were mild to moderate atypical moles and one was called a "persistent or recurrent mole". The path report called for additional excision to confirm the diagnosis. I can't see how it would be recurrent b/c I'd never had it removed before. The spot in question was a VERY small area on my arm that was slightly pink and scaly. The pink TOTALLY blanched with pressure and the scale may very well have been related to the fact that I frequently picked at it to get to an ingrown hair that often appeared under the skin. The pink area appeared to be vascular in nature -- ie, it was just like there was increased blood flow to the area and the area was NOT raised or thickened at all. It was just a little pink.
The pathology report freaked me out and I'm afraid that I really have an amelonotic melanoma. I read somewhere (on google) that recurrent moles can be misdiagnosed as melanoma (so a high false positive rate). Is the reverse also true? Can the diagnosis of a persistent or recurrent mole be a mistake? Could it really be melanoma?
Do amelonitic melanomas blanch completely with a little bit of pressure?
Would a dermatopathologist be able to recognize an amelonotic melanoma? If there was any question about the possibility of a melanoma would that concern have been outlined on the pathology report? I expressed my concern to the dermatologist and she was emphatic that I didn't have melanoma (amelonotic or otherwise). But, she also missed a weird looking mole by failing to move my bra, so I'm not sure how much I trust her. Then again, this is her AND the pathologist -- so what are the odds that they're both wrong?
By way of background, I do have OCD that mainly centers around health issues -- so at least part of my heightened concern is related to that. I am going on vacation next week and will return on 6/28. I have an appointment for the further excision on 7/1.
Any reassurance would be great!
The pathology report freaked me out and I'm afraid that I really have an amelonotic melanoma. I read somewhere (on google) that recurrent moles can be misdiagnosed as melanoma (so a high false positive rate). Is the reverse also true? Can the diagnosis of a persistent or recurrent mole be a mistake? Could it really be melanoma?
Do amelonitic melanomas blanch completely with a little bit of pressure?
Would a dermatopathologist be able to recognize an amelonotic melanoma? If there was any question about the possibility of a melanoma would that concern have been outlined on the pathology report? I expressed my concern to the dermatologist and she was emphatic that I didn't have melanoma (amelonotic or otherwise). But, she also missed a weird looking mole by failing to move my bra, so I'm not sure how much I trust her. Then again, this is her AND the pathologist -- so what are the odds that they're both wrong?
By way of background, I do have OCD that mainly centers around health issues -- so at least part of my heightened concern is related to that. I am going on vacation next week and will return on 6/28. I have an appointment for the further excision on 7/1.
Any reassurance would be great!
Doctor's Answer
by Alan Rockoff, MD, Jun 12, 2009 06:58AM
, Jun 12, 2009 06:58AMTo: TDBC
If the pathologists thought it was melanoma, they would have said melanoma, not persistent or recurrent mole. If you scratch a mole, it regrows and may therefore look "recurrent" under the microscope. You may want to work on your OCD a bit....
Best.
Dr. Rockoff
Best.
Dr. Rockoff
There was absolutely no brown pigment in what was removed. Only a bit of pink, and a tiny (pin point) raised area that was skin colored. Does that provide any helpful information? I just don't understand how I could be diagnosed wtih a persistent/recurrent nevi when I never had any biospy or scars in that area!! Help!
Trust me, I am working on my OCD. It's a bit annoying to other people, but it's far worse to actually live it.
So, just so I understand -- frequent picking at an area (with a tweezer) to remove an ingrown hair could cause it to look like a persistent nevi?
And are amelonotic melanomas also pretty clear histologically? Not more likely to be confused with a persistent nevi>?
If the path report said that further excision was needed to confirm the diagnosis,w hat does that mean (aside from the obvious). What else could it be?