Hi,

I can understand how you are feeling after such an unexpected reaction at your appointment, however I hope I can calm some of your immediate fears by addressing your questions.

Dermatologists, no matter how experienced & quailfied, rarely say if a mole is melanoma just on examination. This is because only a biopsy can give a 100% confirmation of melanoma. In my 23 years of being a melanoma patient, & within all my patient friends, we have experienced the same type of conversation as you. In fact, I had been under the care of my dermatologist for 13 years when I presented with a lump. Just the look on her face told me it was bad news but she couldn't say until I had the results back from a biopsy. They can have a strong feeling it looks like melanoma but they won't commit to voicing it as they have sometimes been known to be wrong! So when they sit on the fence with their comments it's really to protect you - if they followed their gut & said it was melanoma & it came back benign you have had days of terrible anxiety for no reason. I know that 'not knowing' is also causing terrible anxiety but they have to follow this procedure I'm afraid. 

There is also the chance that your thigh mole is atypical (dysplastic) like your first mole is thought to be. Don't be shocked by this, it's actually the best of a bad bunch as it's benign - it just means it has to be removed because it has the potential to become cancerous in the future, so they are just removing the risk! Three of my family members have had atypical moles removed over the years & had no further problems.

If it is melanoma and it is early stage (Stage 1 or 2 - it hasn't grown deep), there is very little chance of spread. If it has spread you would definitely know about it and you would have been seeking treatment from your GP before now! You would either have a large, painless lump in a lymph node (in your case, probably the groin as that's the nearest main lymph node to your mole) or you would have symptoms (constant pain, headache, backache etc) if it had spread to a major organ, the brain or the spine. 

I know it's hard not to, because you are in shock at the moment, but you need to try & let your brain settle down & absorb what has just happened and your body to heal from the traumatic surgery that you weren't expecting. Find a way to relax as much as you can - listen to a meditation CD or Mindfulness CD or your favourite music. Until you can calm your thoughts you can't think clearly & take all this a step at a time. You are young & healthy &, should the results show melanoma, you will be able to deal with it. Treatments are getting better all the time & showing great success so it's not as desperate as it was when I was first diagnosed. I've lived with it for almost half my lifetime & I know many late stage patients whose treatments mean they are still here many years after diagnosis. One step at a time is the key to dealing with this!

Good luck with your results and please let us know how you get on. Deep breaths & be kind to yourself,

Angie (Stage 3)

Hi Angie

Thanks very much for taking the time to respond to my post.  

P.S. How are you?  I hope you are well? 

The day after I made my initial post, I went to my GP as I was really struggling with anxiety and depressive symptoms and feeling very unwell.  She talked me through what has been happening but I felt she was downplaying my fears - she said that it is the dermatologist who would have looked at the mole under the dermoscope and it's more her opinion rather than the plastic surgeon I should be paying attention to - and the dermatologist had said she didn't think it was skin cancer but said they need to be biopsied (although she wrote "dysplatic? melanoma?" on the referral letter to the plastic surgeon.

Unfortunately the GP was concerned by my mental health and said I needed to be signed off work until I get the biopsy results and suggested I try CBT / counselling.

I had felt reassured after the GP appointment, but now it is almost one week on from the excision and the plastic surgeon said that biopsy results would be ready in a week so now I am simply feeling completely nauseous and sick with stress and anxiety about getting a call with bad news. 

All my mind seems to be doing is focussing on the words of the plastic surgeon when he said he would be concerned if I went away for three months without removing it and that it had to be removed.

Everyone I am speaking to keeps saying "even if it is cancerous, you've caught it early" - I can't understand why they keep saying that given it's been on my leg a long time, as long as I can remember, and could have been developing insidiously over many years.

Is it true that if it was melanoma, the shape and colour would have changed very rapidly?  That seems to give me a bit of solace as I don't THINK it has changed and is pretty flat, non-ulcertated, but irregular borders and colour.

I spoke to a cousin who said she also had a similar mole on her arm (black and irregular) and seems to think it is ethnicity related.

I guess what I am trying to tell myself at the moment is that hopefully it is nothing and just a dodgy looking mole and that given my age and ethnicity this hopefully reduces the chance of it being anything cancerous.  

But it's not really helping and I'm just in a constant state of anxiety over this and is really putting a strain on my relationships with family as I'm making them worry so much.  I am particular worried about the fact that two moles were removed so potentially increases the risk of at least one of them being melanoma (I think I've seen you post on here before saying that out of 10 moles that are removed, 8 are usually benign?).

How common would mid to late stage melanoma be in younger people?

I'm so sorry that your anxiety is causing you such distress. I really hope your results come back quickly so that you can deal with whatever they bring. Sometimes it's the not knowing that is worse than knowing what you have to deal with.

I'm no fun of statistics but I think these may help you to see the 'odds' for you at your age & ethnicity. 

Firstly, you have caught both moles early so that really is a good starting point - the fact you hadn't noticed any changes in one of the moles is also good because it means that whatever the consultant saw must have happened recently, otherwise you would have noticed it. When caught quickly melanoma is much more treatable & 95% of patients have no further problems in the future. 

Those at a higher risk of further problems are older (over 80) white patients. Young people have a much lower risk and Asian and black patients even lower.

These most recent stats are from 2016 - newer ones, when published, will show even better survival rates because of the new treatments available that are having great success. 

So, when taken altogether your outlook, if diagnosed with melanoma, is very good because of your age, ethnicity and swiftness of diagnosis. There is still a 75% chance that you won't be diagnosed with melanoma and that one or both moles are either benign or dysplastic so the outcome isn't as bleak as you are focusing on. If it is melanoma, it can be treated & the outlook is still good.

Knowing all this I think it's important that you currently focus on coping with your anxiety as that will be affecting your overall health. Try meditation/relaxation/mindfullness - you can find great videos on You Tube for this & they are really helpful. Go for a walk on a cold, sunny day & focus on the beautiful scenery & the fresh air to try & calm your worries. Your results won't be too much longer & you need a clear head to deal with them. 

I hope this has helped,

Angie

Hi Angie,

Thank you so much for the response.  I took your advice and went on some outdoor walks.

I suppose what I still do not understand is - I am fairly sure that at least the mole on my thigh I have had for as long as I can remember.  As I said, I saw some pictures from a year and a half ago where the mole is present in the same pigmentation and similar shape and size and I am fairly sure I remember having this mole when I was much younger.  

Neither the dermatologist nor the surgeon have any comparison to make in terms of what the mole used to look like. If this were a melanoma, would it have changed in shape and size and rather rapidly? 

I guess I am just scared that it hasn't changed in shape and size on the surface, but may have done so underneath the skin and therefore I've sat on this for many many years and not 'noticed' it because I always accepted it as just a strange looking mole on my leg that had never given me any trouble.

Just trying to process why the plastic surgeon wanted it off so urgently when the dermatologist's reaction two weeks before was, yes it is atypical and very pigmented, but it's not like she was so concerned that she wanted it taken off there and then or very urgently (she said she could do mole removals herself but I said I preferred plastic) - she just gave me the name of the plastic surgeon and let me go on my way and told me she didn't want me to leave thinking I have skin cancer but equally they need to be removed.

Hi,

If you have a photo of your mole from some time ago that you can use as a comparison, and it looks exactly the same as it did when it was removed, there is a lot more chance it's atypical like the dermatologist suggested. Atypical moles look dodgy from the time they appear and there are many people that have them. The difference between the reactions of the dermatologist & the plastic surgeon is that the dermatologist sees many moles every day & they get a feeling for what is suspect whereas the surgeon only sees the moles referred to him for removal & so isn't as 'tuned' to what they are. It's not until they are biopsied that anyone will definitely know if they are cancerous but the dermatologist is slightly more expert than the surgeon. 

Angie

Hi Angie

I hope you are well?

I am going for my outpatient appointment at the hospital tomorrow to have my stitches removed but I expect they will provide the biopsy results tomorrow too.

Tomorrow will mark two weeks since I had the two excision procedures.  I haven't heard anything from the hospital since the procedure other than an automatic text message reminder of the appointment which I received yesterday.

I have found the last two weeks to be really difficult and uncertain and I feel nauseous thinking about tomorrow.  The dermatology appointment and the excision procedures were done at a private hospital. The plastic surgeon told me that my biopsy results would be ready "in a week" and he said he usually phones people if the results are abnormal, otherwise he would discuss the results at the follow up appointment - I reacted negatively when he said this and I think he assumed I wouldn't want to be called.

I know there are so many different possibilities from hospital to hospital, but do you know if its likely they would still call you once the biopsy results were known if the results were bad?  Would they typically advise you to bring someone to the appointment if the results were bad?

I know it might be false hope, but I would think it would be a poor standard of care if they received bad biopsy results a week ago and just allowed me to turn up to the appointment a week later on my own to break bad news.  Surely they would want to get on with further treatment as soon as possible and also give you some warning not to go alone?  I haven't had any of this so far but I may be being hopeful.

I spoke to a cancer nurse who told me they would usually tell you to bring someone, but she also mentioned that private hospitals can sometimes fall in terms patients' emotional care so I'm nervous.  Just not sure whether I could read anything into this or whether I should still prepare for the worst?

Additionally, do you know if it's normal for them to have put non-dissolving stitches into the wounds rather than dissolving stitches?  A few people I know just had dissolving stitches and I'm worried that because I don't have dissolving stitches they did this deliberately to make sure I came back for the follow up appointment as they suspected something bad.

Thanks for continuing to be such a great source of information and support x

I'm sorry I have only just seen your message and you may already be at your appointment. If so, I hope it wasn't as worrying as you anticipated. If you haven't been yet I can only guess at what might happen (other than your stitches being removed) as I have no personal experience of the normal routine of the private sector. It's rare for an NHS consultant to ring with results - they prefer to give results, good or bad, face to face. They will get the nurse or secretary to ring to arrange a follow up appointment or to send it by post. I was given my results when I went to have my stitches removed but that was 23 years ago and since then my hospital changed it's system. We now get an appointment for stitches removing 2 weeks post surgery, and a follow up appointment separately to get the results.

Surgeons differ as regards stitches used. Some use dissolving stitches whilst some use dissolving internal stitches and non dissolving external stitches. It all depends on the depth and location of the surgery (if they have to stretch the skin they may use non dissolving stitches or staples). They won't use non dissolving stitches just to ensure you attend your follow up appointment - mainly because it's usually a nurse that removed the stitches, not the surgeon).

I hope you are taking someone with you, just to be on the safe side. The NHS usually suggest this and I would hope private practice would do the same.

Good luck and please let us know how you get on.

Angie

Hello Angie,

No need to apologise at all.  I just wanted to update you after my appointment today.  The surgeon delivered some really good news to me - both moles were benign 'hyperpigmented compound nevus' - to say I am relieved is an understatement and I feel completely exhausted now!  Apparently my moles are just deeply deeply pigmented, but from what I understand they were not even atypical.  So no further surgery is required at all.  The surgeon even said that had he shown images of the moles to medical students they would all have said cancer and therefore he had been extremely worried.  So I guess I read the room correctly at the surgery, albeit it there were good, unexpected results. 

I feel a bit of a fraud having made such an issue of this when there are many people posting on here with their deepest darkest worries and even diagnosed with serious conditions. 

I am so thankful to you for the time you took to reply to my messages, many of them typed when I was feeling scared and low.  I hope you are well yourself and wish you all the best.

Best wishes,

CL 

I'm so pleased to hear your results were benign. You were quite right in being very concerned and anxious so don't feel a fraud. It shows that only a biopsy can truly diagnose a dodgy mole. Put it all behind you now and enjoy life xx

Hi Angie,

ive been reading your comments on threads and I need some reassurance from you :'(

im a 21 year old girl who has two moles - one on her left arm and one on her thigh. The one on my arm has always been here since I was a kid but was always flat and light brown. When I was in my teens, it started to feel hard and get raised. Stupidly, I didn't do anything about it. When I was 18, it began to itch and bleed and it now looks pink. It's not bled or itched since then but when I was 18 I went to my GP and the nurse told me it was a 'spot.'

anyway, I'm now having EXTREME anxiety that I'm in the late stages of skin cancer and have no chance of recovery because I left it. The one on my leg is also two different colours. I've booked in with a. Private dermatologist but it's not until over 2 weeks and I don't know what to do. I'm not feeling any hope reading these threads because I've left mine too late and could possibly have malignant melonona