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Ask The Expert Archive

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Melanoma Archive Questions

Below are Dr. Kesmodel’s answers to Melanoma questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 25.

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Q : 1

My 22-year-old daughter was born with a Mongolian spot. Over the last year, we have noticed that it is now bumpy in texture. Is this a normal dermatological change?

Most Mongolian spots fade away by puberty. If there are changes in the skin lesion, I would have this evaluated by a dermatologist.

Q : 2

My husband was diagnosed with stage III melanoma in February 2009. It was located in the lymph nodes under his right arm and no entry point on the skin was ever found. All the lymph nodes were removed and he was treated with interferon. In January 2010, there was a light-up of SUV 10 on his PET scan in what seems to be a lymph node deep under his collar bone, but it was biopsied and nothing was found except fluid. Until just last week they called it stable, but in the last PET the light-up increased by 2 points. He has such a terrible degree of stress over the possibility of recurrence that he can't sleep more than 3-4 hours. He can't stop thinking about it, can't let himself relax, and can't sleep. Is there anything to help with the stress?

Although I do not have his imaging studies to look at, the increased activity on PET scan would be concerning to me for recurrence. Unfortunately with melanoma, you always need to watch out for disease recurrence. I do not know how advanced his stage III disease was, so his risk of recurrence may be variable. I would actually recommend that he speak with a professional regarding the stress and anxiety or perhaps get involved with a support group of other cancer patients. It is sometimes helpful to interact with other patients who are dealing with some of the same issues.

Q : 3

Nov 2008 (48years old)I was diagnosed with breast cancer and had a lumpectomy and radiation. I am in a clinical trial receiving Zometa infusions (currently every 3 months). I have now been diagnosed with an invasive malignant melanoma, superficial spreading type, depth of invasion 3.5 mm. I have been waiting 3 weeks for a referral to a surgeon. At what point should I be worried that this is taking too long? Is prognosis for either diagnosis worse because of the other?

I do not believe that the diagnosis of the breast cancer should impact on the current diagnosis of the melanoma. The competence of your immune system, however, is important. Since you have already completed the chemotherapy for your breast cancer, again, I do not think this will impact the current melanoma diagnosis. While it would be ideal to go from diagnosis to additional surgery within 4 weeks, this is not always possible. Certainly I think any additional evaluation and surgery should be completed within 8 weeks, although there is no definite time line.

Q : 4

My mother has a mole on her nose that seemed to spread and get larger and darker for about 3-6 months. Now, it has virtually disappeared. Does a cancerous mole ever disappear?

Yes, sometimes cancerous moles may go away. This is called regression. However, it is possible that disease is still there but not visible. I would recommend a consultation with a dermatologist.

Q : 5

A 28-year-old female, 9 weeks pregnant just diagnosed with melanoma. Breslow l (lesion was 0.65mm) - Clark level iv. Is there any concern over waiting to the 14th week of the pregnancy for the SNB and wide excision?

This is a thin melanoma and the likelihood of it having spread to the lymph nodes is very low. If the entire lesion has not been removed with the biopsy, I would remove the remainder of the lesion with a narrow margin excision if possible and then wait until the 14th week of pregnancy to do the definitive surgery.

Q : 6

My husband had a malignant nodular melanoma, Clark level IV, Breslow's thickness of 5.25 removed and subsequently a wide excision with concurrent sentinal lymph node byopsy which was negative. The doctor believes he has a 60 percent chance of recurrence and is recommending biochemotherapy. Would you agree with this recommendation?

Based on the information you have given me, there is a high risk of recurrence. I would consider discussing the option of clinical trials with your husband's physician.

Q : 7

My dermatologist has done four biopsies, of what I refer to as large freckles. All four came back moderate dysplasia and he surgically removed the tissue. The problem is I have 20 more large or odd spots and he only removes one at a time. Isn't there a way to diagnose and treat more at a time? Is a biopsy my only choice, not a blood test? My mother had breast cancer, and I have a cousin who had melanoma in the eye. It's difficult waiting and wondering, since this seems ongoing.

Excision is really the only way to know whether a skin lesion is a cancer or not. One technique that is sometimes used to evaluate moles is dermoscopy which allows for evaluation of patterns within moles which may make one more concerned about malignancy. This must be performed by someone who is trained in this technique and will not be available at most dermatologic practices. It also does not give a definitive diagnosis. Therefore, you will have to continue close follow up with a dermatologist and excision of suspicious lesions.

Q : 8

I had a squamous cell carcinoma removed from my nose by a plastic surgeon about a year ago. I never had a chest x-ray or blood work. Do I need this? I do see a dermatologist every 6 months.

Usually squamous cell carcinomas of the skin are a local process that do not spread to other areas of the body. If the lesion was small and did not have any high risk features on final review of the specimen then I do not believe further testing would be beneficial. However, if the lesion was larger or had high risk features, then I think it would be reasonable to get baseline blood work and a chest x-ray. Also, these studies could be obtained based on any symptoms that you might be having.

Q : 9

I had a wide incision done on stage I malignant melanoma almost a year ago. This spot is still sore and very itchy. I also noticed that I have more moles in that area than I did before surgery. Is this normal?

It's possible that this may be a reaction to the suture material, however, I would have this evaluated by either your dermatologist or your surgeon.

Q : 10

My husband was recently diagnosed with three 4x4 metastatic melanomas in his arm. I was told that your medical center may perform limb perfusion or infusion. What is the difference and do you offer either of those?

If I understand correctly, your husband must have a history of melanoma and has developed a recurrence with multiple lesions in the arm. We do isolated limb perfusion at our center and not infusion. The difference is the way the vessels are accessed and the type of perfusion. Your husband should also have additional imaging with a brain MRI and a PET/CT scan (if he hasn't already) to make sure he does not have disease anywhere else.

Q : 11

I recently had a small lump removed from my scalp and tested. The doctor said it was pre cancer. What does that mean? Should I be worried?

Pre cancer is a lesion that has developed some abnormalities in the cells and that would eventually develop into a cancer. Many people who have had sun exposure develop these lesions. I think the most important thing is to get close follow-up from a dermatologist because other lesions could develop. I usually recommend seeing a dermatologist every 6 months until no new lesions are identified and then on a yearly basis.

Q : 12

My 14-year-old son has many moles that fit all 5 areas of criteria for melanoma. The first one that was biopsied was ruled as severely precancerous and there are four others scheduled for biopsy. All of this has been done through a physician assistant specializing in dermatology. She seems to be competent and has great manner with my son. Should I start taking him to a dermatologist or should I consider seeing an oncologist? When he was younger, I took him to a dermatologist who performed full body scans, but found nothing and said follow-up was not needed.

I would recommend starting with a dermatologist with at least yearly evaluations if not more frequently. I would also consider continuing with the full body scans. Removal of any atypical appearing skin lesions should also be performed.

Q : 13

I have a squamous cell carcinoma on my leg. It was first frozen off, at my request, but it did not clear up. A recent biopsy showed that the squamous cell carcinoma was still present. I'm going to a plastic surgeon to have it cut out and a skin graft. What do I need to in this stage?

Squamous cell carcinoma is one of the 3 major types of skin cancer. It does not spread outside of the local region that often, but there are multiple tumor characteristics that can increase the risk of recurrence and spread (size, type and depth). If you have an excision and the margins are clear, I would recommend close follow-up, at least on a yearly basis, with a dermatologist. This way if you find any new lesions or have a recurrence, it can be detected and treated early.

Q : 14

In late 2007 -2008, I noticed a light black vertical line down the left side of my thumb nail. I figured it was just a bruise. After reading all of the information online about melanoma, I'm scared. From what I've read, the only way for a dermatologist to know it's Melanoma is to do a nail biopsy of the matrix. Several articles state that after this procedure is done, that the nail will never grow back and if it does, it's ruined because the of the damage done to the matrix. Is this true? Any new procedures for this?

To diagnosis this as melanoma, a biopsy of the nail matrix would need to be completed. Unfortunately, I'm not sure how that would affect further growth of the nail. I would, however, recommend that you see a dermatologist to have this evaluated. If this is a melanoma, early diagnosis is key and often leads to a cure of the disease.

Q : 15

I have been diagnosed with a squamous cell carcinoma on my right calf. I also suffer from a cardiovascular disease that causes a fluid buildup in my legs. What type of skin cancer treatment would be the least invasive to my leg and still be effective in treating the cancer? I am very concerned that any procedure that opens up the skin will result in fluid leakage that would hinder the healing of the surgical site.

I would still recommend the surgical excision. You may have an increased risk of wound breakdown, however, measures can be taken postoperatively to potentially decrease your risk of wound complications.

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