Sperficial Spreading Melanoma

[G8r4evr]

I have a relatively flat mole on my upper abdomen that is dark brown with an irregular border. The main part of the mole is dark brown but there is a very thin border that is much lighter brown.  If you look at the mole, the dark brown  portion looks pretty regular, but it is the small border where the irregularity is noticable.  The mole also appears to be pretty symmetrical.  It is almost exactly the size of a pencil eraser(if not a tiny bit smaller).  I can see what appear to be scaling, but I cant tell if that is just my skin texture being defined in the mole.  It doesnt itch or bleed and the earliest I can remember it being there was about 4 years ago, and it was close to if not the same size that it is now.
I am really worried because I keep reading about melanoma spreading to the lymph nodes and my underarms have been sore and seemingly a little swollen for the last 3 or 4 months, but I do not feel any bumps under there. Also, I have had some minor chest pains and a lingering cough over the last several months, but I am having trouble differentiating between these being a normal cough and maybe just indigestion or perhaps signs that the melanoma may have spread to other areas of my body.  What worries me the most is the stat that I read saying Melanoma is the #1 cause of cancer deaths among women 25-30 and I am a 27 year old female.  The fact that it doesnt appear to be spreading radially at all, just makes me worry that it has begun growing vertically.

I was adopted so I do not know about my fathers side of the family, but there have been no know cases of melanoma on my birth mothers side.  I do have lots of moles and freckles all over my body and I was diagnosed with BCC on my upper back just last week.  I had a few really bad sunburns as a child as well.  I am praying that this is just a dysplastic nevi, but I am so worried that it is melanoma and I have waited too long to seek any treatment.

What are your thoughts? My doctor cannot get me in until late next week. If this is Stage 2 Melanoma or beyond, are there any other signs or symptoms that I could look for?

Cheryl~

[Alan Rockoff, MD]

No, no, no, they are not moving from Stage 3 to Stage 4 melanoma.  People don't get multiple melanomas at one time.  Your nurse practitioner sounds as though she has the correct approach, and perhaps her relaxed attitude, quite appropriate, is what you interpreted as not listening carefully enough.  I suspect she didn't listen--and din;t want to fan your already significant anxiety.  By all means get another opinion if you think you need it, but it is not necessary in general to remove multiple moles.

Dr. Rockoff

[G8r4evr]

I saw the Nurse Practicioner yesterday in hopes of calming my feares of melanoma.  While she was friendly, I still dont feel that she examined me or listened to my fears as intently as I would have liked. I told her that if she is worried about several other moles, I would rather just go ahead and have them all removed at once (as soon as possible) and not drag this out over 6 months.  She again stated that she wanted to wait until she removed the BCC from my back (1/16) and then we can go from there. She said she would then biopsy one of my remaining suspicious moles and if it came back as being precancerous or anything else unusual, she would then remove them all.  I guess she knows what she is doing, but everything I keep reading stesses  early detection of melanoma is key and yet I dont sense any urgency from the nurse.  I decided I would do it her way, but get a scond opinion in the meantime, as there are still 2 moles that I am afraid may be melanoma. So I called 3 Drs offices today and none of them can see me til the end of the month.  I know its pessimistic to think this way, as the days tick by, I worry more and more that these moles may be moving from Stage 3 to 4 Melanoma.  I must say that I did feel better when she said that if there was anything standing out glaringly at her, she would biopsy it now rather than later, but she said there wasnt.  But then I worry as I hear that melanomas are so eary to miss at first glance.

[Alan Rockoff, MD]

Cheryl:

BCC doesn't change odds very much for melanoma.  Just hang in there a little while before you speculate further about Stage 4 melanomas.....

Dr. Rockoff

[Alan Rockoff, MD]

Mainly, because most spots are moles, not melanoma.  Also, most moles are at least a bit irregular.  Also, it's been there for years with what would have to be minimal change, from your description.  Please get it looked at, but I'm sure you'll be fine.

Dr. Rockoff

[G8r4evr]

Hi Again!

So I am starting to feel better, but forgot to mention, I was diagnosed with BCC on my back just last week.  I keep reading that having BCC makes my odds of having melanoma increase.

Do you happen to know approx what percentage of melanomas spread?  Like, can you have Stage 4 melanoma that hasnt spread?  My biggest concern is that I am sure that is hasnt grown larger radially, but Im afraid that just means that it has been growing deeper over the last 4 years...

Thanks Again!

Cheryl~

[G8r4evr]

Okay, Im starting to feel a little better =) Thanks so much for responding so quickly.  Just out of curiosity, what characteristics would make you fairly sure that this spot is just a mole?  The irregularity just has me really concerned...I know its not a large bump, so I pretty much ruled out nodular, but I have read that superficial melanoma will spread as well.  

Merry Christmas to you as well!

[Alan Rockoff, MD]

Please relax.  You almost certainly have just a mole, nothing more.  I certainly agree that you should have it looked at, and your doctor may well decide to biopsy it, if only for your peace of mind.  But there's no reason at all to think that the kind of spot you're describing has already spread.  (Nodular melanomas that grow vertically feel like lumps, by the way, not flat.) I strongly advise you to take your mind off this and enjoy the holiday.

Best.

Dr. Rockoff