possible melanoma - i am scared, please fill me in

[jdt00009]

Hello, I am a 28/white/male with current medical problems which are continuious daily headache syndrome, occasional vertigo, and a benign supraorbital bone tumor of the skull (possible fibrous dysplasia). Very extensive, otherwise normal neuro workup this year. I don't think all that matters for this, but there you go anyway.

Please, copy and paste the following links to see a picture I took of the spot in question for better understanding of my description below (each link is a different snapshot):

http://img206.imageshack.us/my.php?image=mvc035f8kz.jpg

http://img225.imageshack.us/my.php?image=mvc046f7qh.jpg

http://img85.imageshack.us/my.php?image=mvc051f0jn.jpg

The spot you see is on my 2nd toe from the small toe, in between. The spot is very smooth about 7 x 4 mm, totally flat, and feels more or less like normal skin. It is not sensitive, it does not itch, it has not scabbed over in any way. In fact, if I had not seen it I would never have known about it. However, in my docs words, it is irregular shaped, but to me the color looks consistant throughout (dark brown). Basically, it seems like a gigantic, irregular shaped freckle.

I first noticed it in the shower a month or so ago, but it didn't register in my mind. I was clipping my toenails one day and it hit me this could be cancer. I did not see any *blatently obvious* growth during that period of time.

Last week, I saw my internal med doc. He referred me to dermatology but I still have to wait a few more days. Either way, be assured I am seeing a doc ASAP, but first I wanted to ask you a few questions to know what I should expect.

I am scared to death of melanoma.

Please try to answer the following questions as well as add anything else you think I may want to know but haven't asked you:

1) does it look like probable melanoma to you?
2) is there anything else it could *likely* be besides melanoma?
3) should i go in to the Dermatologist expecting to have it cut off for biopsy?  what else should I expect during my visit?
4) if it is confirmed melanoma, how will my doctor likely proceed? in other words, what is the "gold standard" procedure to see if there is metastasization?   Should I expect to have lymph node biopsy in the absense of node swelling? (note: i can't feel any swolen lymph nodes myself).
5) anything else you think i might want to know...

Thanks for you help, it is much appreciated..

[Alan Rockoff, MD]

I think it's an ordinary mole.  The dermatologist might want to do a biopsy, but may well decide it isn't necessary.  The minor irregularity is common in moles in general, especially on the feet.  No worries are needed, and no need to start speculating on what happens if, etc., because it won't.  You've probably had it a long time and just never noticed it before.  See the doctor.  You'll be fine.

Take care.

Dr. Rockoff

[Irish1979]

I think this site might help you some. It is for the Skin Cancer Foundation, it gives some very good information about melanoma.

http://www.skincancer.org/melanoma/index.php

I hope this will help you.

[jdt00009]

Doc,

I think the spot is a little more jagged than is seen in the pictures.  For example, on one end there seems to be a jagged edge, almost as if there are "streamers" or knife-edge dark brown lines trailing out the end of the spot.  Almost as if a sharp knife cut it up.    Do you think this is relavent at all, or do you still think it's 95% likely a benign mole?

[jdt00009]

http://matrix.ucdavis.edu/tumors/tradition/gallery-acrolentiginous-mm.html


Doctor,  If you go to this like, and scroll to the very bottom, that lesion reminds me of mine...its dark brown throughout and the caption says that 'they were surprised to find early melanoma'.

Do you still think I just have a mole?  Should I insist on a biopsy?


I'm rather worried after seeing this.



thanks again.

[jdt00009]

Sorry, I meant to say 'go to this site', and scroll to the bottom where it describes Acrolentiginous Melanoma of the Toe.

[thepurselady]

Awe you poor thing.  I hate worrying about things im sorry you have this.  Sounds like the wonderful Doc thinks its not a worry and he seems like an excellent physician.  Try not to worry and just make a derm appointment.  Yea easy to say I just posted a question and am a mess - but if he said it looks pretty normal I bet  it is!!!  Keep your chin up you'll be fine

[jdt00009]

Hey Doctor, I was hoping you could PLEASE just answer this one follow up question, and then I'll leave you alone,

Today I had a shaved biopsy taken. Results will take a week.  The whole spot is now gone.   However, when I look closely at the red flesh, there does appear to be a patch of very dark red, or almost black spot of flesh, versus the more "normal" looking pink area of the hole.    Do you suppose this this could theoretically be the vertical penetration of a melanoma, and even if it's a benign mole could the lead to future melanoma undetected since healthy skin will heal over this black area left?   The pit in my toe is probably 2 millimeters or so deep, and I though that maybe I am seeing some of the deeper tumor from a melanoma inside there.  

Here is a picture after biopsy today:

http://img238.imageshack.us/my.php?image=mvc074f0xs.jpg

Here is the area of concern highlighted:

http://img102.imageshack.us/my.php?image=74745go.jpg


Thanks again in advance for your help, as I am quite nervous.

[jdt00009]

Hello doc, it's me again... I know you must be quite busy, but I noticed in the past you've been so kind to answer follow up questions for people and I don't have $ to pay another question.    I was wondering if you could please just take a minute to respond... I did get my biopsy results back and they said it was NOT cancer, BUT there are some "unusual cells" and that I must now have a wider excision.   Could you please tell me what this could mean.   Early melanoma?  Pre-cancer?   Please advise me

[jdt00009]

Today the doctor did a wider excision of the area, and is going to send the tissue for yet another biopsy.   He called it an atypical mole, but not cancer.   Is this any reason to be concerned due to the fact that another biopsy is being done?

[hprees]

What ever happened when they took more out?  I went in Thursday for 2 small moles to be scraped (about the size of a sesame seed) but they were very dark but round for the most part.  He said they were atypical.  I will hear next week and like you were - I am FREAKED OUT. I have dark hair and eyes but skin like casper.  I stay out of the sun but got some burns as a child.  Since they were both on my leg area that scares me too since that is where melanoma is on women.  I think the one on my toe was there for about 5 years or more and never grown at all.  The one on my shin seems relatively new (a year or so) and that scares me too.  Any comments?

[sabrin42]

A related discussion, dark freckle could it be malanoma was started.