What would you do?

[kwalsh]

I am a sun worshipper - terrible I know but I am now putting 45 spf on my face and 30 on my body.  I recently noticed a new mole that formed in the middle of my upper lip (above lip below nose).  I asked the dermatologist about it and he said it was fine and if i wanted it removed it would be cosmetic and I would have to pay.  I let it go for a few months but was getting frustrated with people telling me that I had ink on my face (it had a blue tinge to it) so I opted to have it removed. I paid the fee and when i received a call back from the doctor's office telling me that he was surprised but the pathologist had recommended a 'conservative re-excision'.  He has told me that it is up to me because it will require lip reconstruction because to remove any more tissue will deform the upper lip.  Here is what the pathologist report said:
this is a markedly atypical lesion however based on the represented portion of the lesion, a diagnosis of a benign deep penetrating nevus with atypical features is favoured over an invasive melanoma with perineural invasion.  Deep penetrating nevus is favoured because of hte wedge-shaped orientations of hte lesion, discrete nesting pattern, and architecture which suggests that this is a small papular lesion. However, this lesion is associated with overlying lentiginous hyperplasia of melanocytes, there is a degree of melanocytic atypia, host inflammatory response, prominent solar elastosis, and extensive perineural infiltration of melanocytes. A conservative re-excision specimen is recommended to completelly exclude a nondiagnostic sample from an invasive melanoma arising from a background of lentigo maligna."  The problem is that a conservative re-excision will require full lip reconstruction....I don't want to deform my face for no reason and yet, I don't want this to become melanoma.  The tissue fragments submitted measured 0.2x0.2x0.1cm .

What would you do?  And what I don't understand is that the dermatologist originally said I didn't have to remove it and that it was cosmetic.  Do you think that I can just monitor it and if any new colour or mole reappears then go for re-excision?

[Bhupinder Kaur, MD]

Hello,
Since the pathology reports has shown cellular atypia which may be due to melanotic lesion and there is a possibility of lentigo maligna, it needs further evaluation. It is a form of melanoma in situ that consists of malignant cells but does not show invasive growth. It typically progresses very slowly and can remain in a non-invasive form for years.

I agree with your dermatologist as it needs further evaluation. However my advise is to get it physically examined from another dermatologist and get a second opinion.
It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your dermatologist. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[aannie12334]

well the treatment of choice for these types lesions is complete surgical removal. If the biopsy does not contain the entire lesion one may wish to conservatively re-excise to fully evaluate the lesion and prevent recurrence. Another option would be to follow up the site and only re-excise if the lesion should recur. As my mother has had melanoma that started just from a small mole I would strongly suggest getting this procedure! because I know I would rather have a small deformity to my face than have the big C. if it turns out to be melanoma im sure you could find a way to get your money back from getting the procedure done the first time since it was kinda negligent.. but its totally up to you! if you feel more comfortable you can just keep an eye on it and go in for regular check ups. if anything changes then you should def. get the procedure done. best of luck!