Mole--Waiting for more results

[CambridgeC]

My breast surgeon noticed a mole on my abdomen that he thought should be biopsied (I have recurring cysts in my breast and receive regular follow-up care). It was a mole that I’ve had since childhood, possibly since birth. I hadn’t noticed that the borders were beginning to be a little less defined (extremely small lines extending from the edge), but when my doctor pointed out some irregularity, *then* I noticed.  It was slightly smaller than a pencil eraser and looked dark brown to me, but the surgeon noticed that it also had color variation.  



It hadn’t grown or changed markedly, but my physician certainly knows his ABCDs so it was promply and completely removed.  I have almost no moles on my body, and this one was certainly something that stood out among the rest of my light skin.  There is no history of melanoma in my family, but I have light hair/skin/eyes. I have not had any significant sun exposure in 15 years since I was diagnosed with systemic lupus at age 23 (I am 37 now).



I received results on the biopsy five days later--a painfully long wait. Initially, the nurse who shared the results with me apologetically said that I had melanoma. I asked her to read exactly what it said on the report.  She said it indicated an “atypical compound melanocytic lesion.” I called my doctor that evening, and he said that three local pathologists had looked at it, and concurred on an atypical mole diagnosis (NOT melanoma—or at least not yet). Apparently, the pathologists had some difficulty reaching consensus (although I don’t know what the debate was, exactly), so they sent my tissue to Hershey Pennsylvania to a “highly experienced demopathologist.” The degree of atypia was not noted, but the fact that there is confusion about the diagnosis is creating extreme anxiety for me since I am now waiting another 7+ days for this.  I think it is the wait, and perhaps the nurse’s original “diagnosis”, that is feeding my fears—-and I feel that my reaction isn’t unusual, under the circumstances



My questions:



1. Will the new pathologist look at exactly the same tissue/slides as the first three?  

2. If there is debate about the diagnosis, is this a good thing?  I want to reassure myself that the debate means something “borderline” and that "borderline" might mean something superficial if it comes back malignant.  The weeks of waiting are torture.  I want to prepare for being able to hear if I have a serious melanoma, if this is likely.  

3. If the diagnosis comes back as being an atypical mole, my biopsy margin was very narrow—should I have my surgeon remove more tissue since I assume some of the atypical cells, although no longer visible, are at risk for becoming malignant?



   They are biopsying an area on my perineum on Friday (small discoloration) "just to be safe."  Of course, this will be another week's wait.  Medical procedures feel an awful lot like dodging bullets. I appreciate your answers and thoughts.



Kris

[Alan Rockoff, MD]

1.  Yes.

2. Pathologists often have some measure of debate about pigmented lesions.  However, it seems clear that you don't have melanoma--the only question is the degree of atypicality.  No one even knows whether atypical moles will progress to melanoma, so the usual prudent process is to take them off.  The margins of normal tissue recommended depend on how atypical the mole is judged to be, but in no case are they as extensive as they would be for actual melanoma.



I would rely on the judgment of the Hershey dermatopathologist over those of the local pathologists.  I would not in any case worry about actual melanoma, which you almost certainly don't have.



The nurse's behavior, as you rep rt it, is outrageous and unacceptable.  You must bring this to the doctor's attention, so that only personnel who know what reports mean pass the information on to patients.



As to the one-week wait, I will only note that my own skin pathologist gets reports out to me in 24 hours.



Best.



Dr. Rockoff