Moles, doctors, lab results, and the modern man. A medical inquiry.

In My Humble Opinion
1

I was about to post this in GQ, since it doesn’t necessarily ask for a diagnosis, but I decided to put it here instead to give myself a little more latitude in that regard.

One point five weeks ago, I had two moles removed by a plastic surgeon. I’m fair skinned and have a decent collection of moles, the ones I had removed weren’t any more or less “suspicious” than others, I just had them removed for mostly cosmetic reasons. One was on my cheek and tended to make shaving difficult, the other was on my arm and tended to get snagged on things.

I guess for customary reasons, the doctor had them sent to the hospital’s lab for testing after they were removed. A week later, when he was removing the stitches, he said that the lab on the arm-mole came back negative, but the mole from my face had something so they sent it to the lab at University of Michigan for more conclusive tests, and they’d call me when those results came in.

Alright, I thought, if it does turn out to be something, the fact that it and the immediately surrounding skin have already been removed should mean no big deal.

Then today a nurse from his office called me and said something to the tune of, “Your lab results came back today, we need to make an appointment for you to see the doctor.”

I’m no George Costanza, but could that phraseology not be designed to inspire the most possible dread?

If the results were fine, they’d just tell me on the phone. Since they didn’t, they must want me to be there in person, sitting down, when they tell me I have 4 weeks before my entire face melts off Raiders of the Lost Ark style.

Or perhaps they just want to get another office visit billed to my insurance.

The guy’s just a plastic surgeon, he spends most of his days sucking fat out of people or tucking their tummies. If the news were completely dreadful, it seems like he’d refer me to an oncologist or something. My best guess is that the labs returned some kind of weirdness, but since we cut it out you’re fine now, maybe we’ll run a test or two, have a lollipop.

Though I pride myself in level-headedness, ever since I hung up the phone I’ve been feeling spiky tendrils growing from my face, twisting around my body like some kind of alien taproot. Since my appointment is in a week, which, for those unfamiliar with measurements of time, is nine hundred thousand days, I imagine these feelings are only going to get worse.

So, since this is in IMHO now, lets take a poll: Am I going to die or what?

2

Depends on the kind of plastic surgeon you went to. Did you go to a Nip/Tuck type one? Or a regular one.
Plastic Surgeons cover a lot of territory, its not all tumy tucks and tit jobs.

3

I wouldn’t read anything into the fact that they want to talk to you.

The only kind of mole that’s gonna kill you any time soon is melanoma. If you had it removed for cosmetic reasons, it’s not very likely melanoma. Most other skin cancers are sort of benign once taken off.

But on the chance you might be dead soon, here’s a joke for you to liven up your last days:

Guy goes to the doctor for his test results.
Doctor: Good news or bad news first?
Patient: Gimme the good news first. It will help prepare me for the bad.
Doctor: Your test results are back. They show you only have ten days to live.
Patient: What the ??!! What’s the bad news, then??!!

Doctor: Your tests came back last week.

4

If the mole ends up being basal cell carcinoma, they want you to come in to make sure they’re removed all the cancerous tissue. It’s slow growing and not deadly, but it can be disfiguring.

I had a flesh colored “thing” on my face by my nose in 2000 that would bleed every now and then. When I went to the dermatologist, he saw it and took it off my face immediately (well, I was numbed first) and that scared the crap out of me. When it turned out it was basal cell, I had to go back in to have surgery (outpatient – totally painless) for them to get rid of the remaining tissue.

I had some stitches and there’s a scar, but it’s right in the crease of my nostril, so it’s not noticeable.

The tissue was tested and they got it all.

5

Man, if they have to go in and cut more out I’d be pissed, unless I could specify the shape of the scar it’d leave so I could tell people I was in a knife fight to defend a group of ducklings or something.

6

Just having you come in doesn’t mean it’s even cancer. My bff found a lump in her breast, had a biopsy, and was told they’d call her with the results. Doctor calls and has her schedule an appointment. When she gets to the clinic, they have her undress, put on a gown, get up on the bed. Then the doctor comes in and tells her she doesn’t have cancer and she can put her clothes back on and leave.

I guess they just wanted to make sure her heart was functioning properly!

Good luck!

7

It would be rather fortuitous for you to have had the mole removed for purely cosmetic reasons only to find that it was melanoma. That it didn’t look odd would seem to indicate that if it really was melanoma, it was probably in the early stages.

It may merely have come back “atypical” or such (my wife received a postcard reporting this result) and the doc wants to make sure that they got it all, it isn’t regrowing, or check you over again for any other unusual moles.

8

That makes sense – they want to look you over to see if you have any more they should take off as a precaution.

I had a few moles removed once for pretty much the same reason as the OP – one on my wrist that kept getting chafed from my sleeves, it would get all red and itchy – and they called me the next week to tell me the biopsies all came back clear. I had no idea they had even sent them out for biopsy. They never mentioned it.

9

Especially since it means the doctor can report it to the insurance as an excisional biopsy, and presto changeo I dont have to pay for it myself anymore.

Apply that to your healthcare reform debate however you may.

10

Your situation sounds a bit like mine. I have a lot of moles and five years ago I noticed one of them looked like a Venn diagram. So on my next annual-ish visit to the dermatologist, I pointed it out to him, and he removed it. I called for the biopsy results two weeks later like I did every time the derm took off a mole he didn’t like. I had many moles removed before this over the years. But this time the nurse wouldn’t tell me the results over the phone. She said I had to talk to the doctor, and he was out of town for two days. :eek: I finally caught up with him, and my mole was melanoma. :eek:

The derm had me back to take off more skin around the punch biopsy to make sure he had clear borders. When those results came back he said I was clear. The initial biopsy showed that the melanoma had not moved into the skin in any significant depth. The term the doctor used was “melanoma in situ” (it’s in one site and not spreading). Cancers are often described in stages from 1-4, where 4 is the most serious. He said my mole was “stage zero”. :smiley:

I had a scary week or two waiting for the results of the second biopsy, and was often worried, but that’s all I needed. No drugs, chemo, radiation or whatever. This was five years ago. I see the dermatologist every 6 months now, and if any mole looks the least bit suspicious to either of us, off it goes to the microscope. No other problems since. I’ve gotten to wearing a wide-brimmed hat almost all the time, and I am a fiend about sunscreen now.

When I saw him a couple of weeks ago, I asked if my history of melanoma should prevent me donating my organs. He said no, that I wasn’t “in remission” - I was cured. Very nice to hear!

My point is that you may very well be in for some bad news, but it is much better to deal with it sooner rather than later.

11

I should add that most likely there’s nothing wrong, or it’s not that serious. Melanoma is a scary cancer, but there are other skin problems that are much less serious that still require a doctor’s attention. My advice is for you to hang in there, and get to your follow-up appointment.

12

I’ve had so many really bad sunburns in my childhood I’ve always sort of expected some kind of cancerous flareup in later life, I just figured I’d be rich and famous at this age that I could afford some kind of experimental easy-fix that wouldn’t require damaging my physique.

13

Could be their policy is to not tell people anything over the phone at all, good or bad.

14

Speaking as a pathologist who sees lots of moles and the occasional melanoma:

  1. There’s no way I’d wait a week before finding out what’s happening. Since you’re understandably concerned/wondering what’s going on, can you stop by the office to pick up a copy of the report (to which you should be entitled) before the followup visit?

  2. The biopsy result isn’t necessarily melanoma. There are “atypical” nevi (a.k.a. moles), which have some clinical and/or microscopic feature(s) in common with melanoma but are considered benign. As noted, your doc might want to check other moles on your skin to see if they might look atypical and warrant removal, or to do a full-body skin check (if not already done) to make sure you have no worrisome-looking lesions. Or if a mole that was removed was called “atypical”, it might be that the lesion went to the margin microscopically, so they’d want to take a bit more skin to assure a clear margin.

A previous poster mentioned melanoma in situ. What this diagnosis means is that the malignant cells are entirely within the epidermis of the skin, tumor has not invaded the dermis yet, and there’s no metastatic potential if the lesion is removed at this point. (Just explaining terminology here).

Hope all turns out well for you.

Jackmannii, M.D.

15

I’m one of those people who is severly at risk for skin cancer. I’ve had eight moles removed in the last several years. Only one was moderately dysplatic, and that one they had to go back and remove more surrounding skin. Right now I’m fighting the battle of the solar keratoses, and my dermatologist is freezing them all off.

Is your surgeon a certified Dermatologist as well? You may want to consult one for a second opinion if not.

16

Alright, I’m leaving for the doctor in about 3 minutes. If you don’t hear from me within 4 hours, I’m probably in a bar trying to kill a tumor with alcohol.

My best guess is that it was a weird mole, and now he wants to look at the rest of my moles to see if there are any other weird ones, as has been mentioned above. That would take about a week though, I’m probably more mole than human, epidemiologically speaking.

17

Good luck!
ETA: Wait, you posted that an hour ago! Are you back? What’s the what?

18

The dawn fades, I shake loose this mortal coil.

Alrighty, I’m back. The news isn’t necessarily bad, it’s just annoying.

I have the lab report in my hand, and it’s a stunning read of airport novel proportions.

The report for the mole from my arm, the weirdest-looking mole I’ve ever had, is all of three sentences.

The mole from my face, which is the subject of this whole tread, warranted a manifesto spanning an entire page.

“The nested arrangements show maturation toward the base, while the single cells do not. Many of the single cells show nuclear enlargements and nucleoli. Occasional single cells feature intranuclear cytoplasmic inclusions.” That’s just the preface.

“This lesion has some worrisome cytologic and architectural features. For that reason, it was sent to the University of Michigan for an expert dermatopathology consultation.” I love the term architectural features.

So a piece of my face is removed, put in a bottle of formalin, and scurried up one storey to the hospital’s lab. They find worrisome architecture, so it’s placed on a truck and driven two hours to the university. There are pieces of me all over this state. I left my heart in San Francisco, I left my face in Ann Arbor.

UofM’s Dermatopathologist took that chunk of skin and performed all kinds of crazy tests, including immunohistochemical staining. The report actually says, “He concurs that this is a challenging lesion which is difficult to classify with certainty.” I love it. I have challenged and stumped a doctor who has published articles with such titles as Cluster Analysis Of Immunohistochemical Profiles In Synovial Sarcoma, Malignant Peripheral Nerve Sheath Tumor, And Ewing Sarcoma and Telomerase Expression In Sebaceous Lesions Of The Skin with my weird facemeat.

This doctor writes, “At the very least, it represents a borderline neoplasm of uncertain biologic potential. The differential diagnosis could include a nodular dermal melanoma arising within a longstanding nevus, an atypical proliferative nodule […], or possibly an atypical compound combined nevus with ordinary and atypical spitzoid components.”

Spitzoid components. I had the damn thing removed because it was hard to shave around it, and now ink is being spilt about spitzoid components and intranuclear cytoplasmic inclusions.

The short version is: Nobody knows what the hell it is, but since it could be something bad, the doctor wants to re-excise the area to make sure it’s all gone. The lab says the weirdness extends to the border of the sample, so there might still be some spitzoids in my face.

So I’m doing that on Thursday. The wound is just now finishing healing, and I get to go and have the whole thing done over again. More anesthetic injections “There might be some sliight pressure.” “Oh, ok, I can handle a little preasSSAUAEAHAHAHAHHHHGHGGGGGGGGOWWWIE” and another damn week of stitches.

Sucks.

Spitzoid.

19

Here’s hoping the spitzoids don’t kill you, as I find you rather amusing.

20

I was with you until ‘spitzoid.’ There’s a term I’ve never heard before…Fortunately, I already am logged into Pubmed.

Wow, okay, found a 2007 article from the British Journal of Dermatology. I’ll summarize, but let me know if you want the article itself.

So, spitzoid refers to a “Spitz naevus” which sounds like a benign mole, characterized by a specific type of cell. However, there’s a lot of debate regarding the criteria to define the “Spitz naevus” and telling it apart from a melanoma is apparently difficult, and a focus of malpractice cases. And…then the article goes on for ten more pages about molecular methods to tell these two lesion apart. I am really, really grateful I am not a dermatologist at this point.

Well, I guess it’s good that they are taking the rest of it out, just in case. And now I know a new word. Everyone wins?