cause for concern?

[rara11]

Hi,
I am a 46 yr-old female, Irish-fair skin, always freckled easily and have many freckles/several moles.  I had several (at least 6 or 7) severe sunburns in my youth.  I now try to be careful in the sun, particularly because now in my 40's the sun exposure increases my freckles and I also sometimes get "sun spots"--brown, flat moles (? what do you call them?), not raised or discolored, just light to medium brown spots. These seem to occur even with sunscreen. I noticed a very small/pinkish spot on my cheek several months ago.  I also have a large sun spot (brown, flat mole) on my chest (above my left breast)that is about 5 mm in diameter, possibly a little bigger.  (The doctor says he needs to check this because it is bigger than the others on my body.) It appeared in the last couple of years, from the sun, and I was not concerned until now. It is oval shaped, slightly irregular, light brown with a just a little tiny bit darker shade on one edge.  It is not raised, itchy, or sore.  I went to the dermatologist today for an overall check. He is concerned about possible basal cell cancer, perhaps more ? (he didn't say)for both areas I mentioned above.   He said that he doesn't think it could be melanoma. He is going to do a shave biopsy in 4 weeks. I am concerned!  I read that a shave biopsy is not used for melanoma biopsy.  How does this all sound to you? I am a little scared. Thanks!!

[Alan Rockoff, MD]

It's hard for me to say with certainty, but the spots you describe, while more than likely not cancerous, sound like they raise suspicion not for basal cell (which is usually pearly and pink) but for an atypical mole or melanoma.  It is true that deeper biopsies are recommended for suspicious melanoma, but shave biopsies can give adequate tissue to diagnose many pigmented lesions.  I would share you concerns with the dermatologist--perhaps with a phone call or letter--and find out what he's looking for and whether he would consider doing a punch biopsy.  Don't be embarrassed to ask.  You deserve to know his reasoning.

Take care.

Dr. Rockoff

[rara11]

Thank you.  I am of course afraid of all this. I realize you can't be sure and I guess since the size was the only thing different that maybe I was OK. I was reassuring myself when I read about shave biopsies.  I guess I see your point about what my doctor may be looking for.  I meant to say that he did say that we could watch and wait if I preferred not to do a biopsy. Is that common? I will ask about the procedure but wouldn't it be more common to do a more invasive biopsy in this case if there is that concern? I guess I am just scared. Thanks again.

[Alan Rockoff, MD]

If the doctor was willing to wait, he wasn't that worried.  Maybe a simple shave just to settle the matter would be good.

Dr. Rockoff