Skin Cancer Forum - Melanoma wrong diagnosis

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Q: Melanoma wrong diagnosis

asked by: ChrisG22 on June 23rd, 2009

New User

Heres how my story went:

About 5 years ago i got a mole on my back that was illregular (had different shades and colors around it). I went to a mole scanning clinic and they took pictures of it and said nothing to worry about. I don't think i'v seen any noticable changes but there could have been small changes and since its on my back its hard to see. 5 Years later, I decided to do a mole checkup, they said that it was suspicious and wanted to watch for it and any changes in 3 months.

Anyway, there was a change in color. The mole is about 1-1.5cm in diameter. They did a "shave biospy" and injected me with a needle and i think they shaved it off. I think it might have been bleeding. The doctor said that she doesn't think its a melanoma. She also said "This is deep enough to remove the mole". Anyway 3 days later, she rang in and said after biopsy the mole was a melanoma but it was in its early stages and that i caught it early. I think she said that it was only in the epidemis in a small section. Anyway i went on the internet and find out "Shave biopsy" cannot determine the stage of the mole as it can't give the full depth. Now i'm thinking she is unqualified and i'm worried this has spread more than her diagnosis.

I guess what i am asking is, can they guarantee that it is ONLY at stage 0 through a shave biopsy? I'm not asking about identifying which stage it actually is but whether it is stage 0 or something later.

Replies(12)

ChrisG22

replied on June 23rd, 2009

New User

Actually i don't really know if it was a "shave Biopsy" but she did mention "shaving it off" And the area has been sore for about 5 days now and she gave a needle to make it numb before she did it. And she also put a bandage and cotton wool over the top of it.

ChrisG22

replied on June 24th, 2009

New User

To answer myself. I think she did "Saucerization" or a "deep shave". After doing deep searching, i found this type of skin biopsy.

My scar looks way too bloody to be a shave biopsy and has taken a week to heal.

JACK37

replied on September 3rd, 2009

Experienced User

I know it is three months later but I did not see this before. A shave biopsy is only a biopsy. Melanoma should be toally removed with a margin of skin to check out. How deep was it. Did you get the biopsy report? Well how are you doing now? How does that area look? I had a big problem with doctor who told me not to worry. Well, eighteen months later I had to have big surgery for area I asked them to check out. It was not okay at all ....it was melanoma.

ChrisG22

replied on September 4th, 2009

New User

re-excision.

Originally it was a shave biopsy. It had a 1mm depth of skin. But the report said the melanoma was well clear of the margins. 2 Weeks later, They did a full depth excision. I went to a plastic surgeon to do it to be sure. They did a 1cm margin (Skin specimen was 4cm(width) by 2cm(height) by 1.5cm(depth) but it wasn't mohs.

The second report (The full excision) said they found a scary wound in the middle of the cut out (From the shave biopsy) and no evidence of any malignancy. I'm more worried because the first report said it was melanoma in situ but they found lymphocytic regression (This would have been in the top layer of the skin - epidermis as the shave biopsy doesn't go far into the dermis). There exact words were "Active lympohocytic regression in the area". Doesn't tell me if its extensive or not. No lymph node tests were done. I heard that you cannot diagnose a melanoma in situ if it has regression. But then i guess they found nothing in the second report which contained the dermal layer so in therory it shouldn't have previously made it to the dermal layer and regressed.

JACK37

replied on September 4th, 2009

Experienced User

What was the Clark level? How dept was the melanoma? How come no one check your sential lymph node? I had a .75mm on my head. I had a large area (2cm X 2cm) removed from my head and check out and my sential node checked out too. I was told this was the best thing to do. That was two year ago and all is till okay. My friend had it the same time I did. She had it does the shave biopsy way and that's all. Two months later she had to get it redone. A years later she had it somewhere else. She is not doing good. Call one of the clinic like Mayo or Sloan Keating up and ask them about it. That's what I did. Jack

ChrisG22

replied on September 5th, 2009

New User

reexcision

Well i has a full excision 3 weeks after shave biopsy diagnosis and they didn't find anything other than the scar from the shave biopsy.

They diagnose the clark level as 1. They didn't provide a breslow depth, it just says says small area, Clark level 1 and no dermal invasion with active lymphocytic regression and a very small amount of pagetoid spread. The GP said that the sentinel lymph node test was not necessary. She was saying the melanoma was so small that a breslow wasn't even measured. Referring that it was 0.1 something but it didn't say this on the report whether she was right or anything.

But i guess you go a sentinel check because it was on your head where there is less skin depth. Mine was on the lower back where there was alot of skin.

ChrisG22

replied on September 6th, 2009

New User

Also may i ask, did you friend orginally have a melanoma in situ? or was it larger? What clark level was your melanoma?

I think i didn't get a breslow depth because the clark level is independently significant on clark level 1 melanomas.

JACK37

replied on September 6th, 2009

Experienced User

She had melanoma in situ. No clark level was given to her. My clark level was 3. Breslow depth was .75mm. My margin was clean and my lymph nodes were okay too. That was two years ago (9/11/07). I was getting a CT every three months for a year and now get one every years with blood work too. I now see a very good dermotagist(spelling bad). I see her every three month. She was busy with my skin problem at first but now she can not find anything on me at all. I keep out of the sun and use blocker every day. I also see a oncologist. Frist very three months now once a year. Are you seeing an oncologist? They know all about this cancer and can help you out. You must have the right doctor to make it thur this. I went to a bad one at first. I try to take him to court but my lawyer settle out of court but he is still in business. There are a lot of bad once out there. Melanoma is a real killer. You must make sure no cells got away. Good luck. Jack

ChrisG22

replied on September 7th, 2009

New User

What? How did she have melanoma in situ, but no clark level?? clark level 1 is suppose to be melanoma in situ, so if they didn't diagnose the clark level how did they know it was melanoma in situ?

I'v been reading up on this, when you have clark level 1, a breslow is not required. However non insitu melanomas require a breslow.

Wait, when they reexcised her 2 months after, was it another shave biopsy or a full depth excision? What margin did they use? Sounds to me that when they did the shave biopsy a bit was on the side, then it grew over 2 months then they only excised a situ margin which was not enough by the 2 months had passed. I asked for a 1cm margin with the plastic surgeon even though it was diagnosed as in situ melanoma because i'v heard reports that 0.5cm is not enough.

Well i'm gonna get myself a proper dermetalogist to overlook this. I have a GP who is doing this.

JACK37

replied on September 7th, 2009

Experienced User

She went to the wrong dermatologist. He has a few PA work for him that do all the work. Biopsy which I saw was not a full report and that also is done in the doctor office. Just the wrong doctor. Sorry case but it happen everyday. I was stage 1A. I am seeing two sets of doctor, one not know about the other. Are you seeing a dermatologist and a oncologist too. You say you have a GP was it that? I hope it not a General Practice doctor. Jack

ChrisG22

replied on September 8th, 2009

New User

What do you mean the biopsy was not a full report? Did she get a positive deep margin on the shave biopsy or something? I had a shave biopsy but the melanoma was "well clear of the margins" as my report says, then they re-excised the melanoma with a 1cm deep wide excision three weeks later and found nothing.

Yep, I go to a skin cancer clinic, but they are really just general practitioners specialized in skin cancer, so might be worth getting a dermatologist to double look over things just to be sure over the next few years. I went to a plastic surgeon specializing in melanomas to remove the melanoma and he overlooked the biopsy report and he assured me there was nothing to worry about.

However reading over the report, i think its gonna be ok. Do you know from the margin how much they actually do cut out? Is that the margin of how much melanoma cells must be clear of or is it a margin around where the whole mole area was?

My original mole was 8mm X 7mm (width & height) in total size, but the reexcision was 40mm X 20mm X 15mm (width & height & depth). When you subtract 7 from 20, you get 13, leaving 13mm of non mole skin from the top to bottom and a radius of 6.5 (if you share it equally).... Doesn't that mean 6.5mm margin???

However my melanona cells was less than 0.1mm wide so i guess 20mm makes 10mm each side???? Is it a margin of the melanoma cells or the mole????

JACK37

replied on September 8th, 2009

Experienced User

When they did my operation there was no more cancer left the biopsy was all the cancer I had. I had a 40mm circle removed from my head. Before I had it done I checked out what Mayo and Sloan Keathing would do. They both told me to get it done this way and seeing a Dermatologest and an oncologist was also very important. These doctors just deal with skin problems and cancer. They are the ones you need. No one know the future but I feel being safe is better than sorry late. You should check "melanoma blogs" on the web.

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