Post#269 » by Sedition » Tue Mar 16, 2010 4:54 am
DD: Long time bro, I've been good. Life has been much better now that I'm finally back in LA and away from that horrible place called Boston. I'm not in private practice yet actually, I'm currently in a surgical "residency" training program. The hours have been rough (worked 110 last week, which is technically illegal by ACGME standards, but no one ever really blows the whistle because it makes us look like we're not team players). But hey, I can't complain, I'm back in my home town and near my family and friends again. =)
SK/DB: What's this studio talk about?? You working in the entertainment biz now? Sweet!
J-far: Yeah, that link you just showed there is what they call used to call the ABCD's of melanoma: Asymmetry, Border irregularity, Color variegation, Diameter >6mm. It's also now been updated to ABCDE to include E for "Evolution" meaning that the lesion is continuing to change in size, color, etc. over time). Those are signs that are SUGGESTIVE but NOT necessarily diagnostic that your skin lesion may be melanoma.
The only real way to know for sure is to take a biopsy of the lesion. Theres a few ways they can do that. If the doctor's suspicion is low, they can just do what they call a shave biopsy and take off the top layers of your mole and look at it under the microscope. The problem with a shave biopsy is that it wont tell you how DEEP the lesion goes into the skin (since you only took off the top layers). Thats why they only use it if your suspicion for malignant melanoma is LOW (it basically just confirms that yes it is malignant or no it is benign).
The other thing they can do is what they call a "punch" biopsy. That one is basically like a big needle that goes deep into the mole and soft tissue underneath it. It will not only tell you if the lesion is melanoma or not, but also if it is melanoma, how deep the melanoma invades. Keep in mind that depth of invasion is one of the most significant measures of how serious a melanoma is.
The sort of final option for biopsy is what they call excisional biopsy. That's what they do when suspicion for melanoma is high (based on the ABCDE's). In that case, they use a small elliptical incision to take out the suspicious lesion. Then they can look at it later under the microscope and find out if it is melanoma or not. The drawback of this is that it is the most invasive, and will leave you with a small scar. The benefit is that it is BOTH diagnostic AND in some cases therapeutic (because they can diagnose whether the lesion is cancerous by looking at it under the microscope, AND if it does turn out to be cancer, they've already excised it anyways).
So long story short, if you've had the mole for a very long time, and it doesn't look like melanoma based on the ABCDEs, its probably nothing more than a benign nevus. You're probably safe just watching it for now, and then going to the doctor if the mole ever starts to change (or "evolve" a.k.a. the E in the ACBDE's of melanoma). However, the only sure way to diagnose is through biopsy, and you can get that done usually by a Dermatologist. If you wanted to play it safe, I would just go to the dermatologist anyways and then let the doctor decide if they should biopsy it or just watch it for now (since they're the experts and they do nothing but look at moles pretty much all day).
Take care dude!