Dermatologists opinion vs GP, surgeon and oncologist

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    • #12326
      Anonymous
      Inactive

      Hello all, my name is Frankie and I am a 50 year old caucasian female who was diagnosed with melanoma in situ on the sole of my foot in March of 2016. I underwent a wide local excision with skin graft in April 2016 and have been told margins were clear. The initial lesion was just under 2 mm and while it didn’t grow over time it turned from light brown to black. It was a new mole that appeared over a matter of a few months.

      This past Wednesday i had 3 more moles removed for biopsy from my back. I am now in the waiting game. And as i sit and wait i can only think “why was it my surgeon who found these and not the dermatologist?”. During this process i have met with 2 dermatologists who have both been dismissive with me. with the first it took 6 months for me to convince him to remove the mole from my foot, if anything just for peace of mind. He did it begrudgingly and was surprised that it came back as melanoma. The second dermatologist dismissed me after my second visit with her stating i only needed to go back if there was a change. She also said a change in a mole wasn’t necessarily cancer but could just be a reaction to inflammation. This is the opposite to what my GP, surgeon and oncologist have advised me.

      Has anyone else experienced conflicting information from the medical professionals? How do you manage it? Do i ask for a third dermatologist? It all seems crazy. Shouldn’t the dermatologist be the one doing biopsies?

      I was happy to find this site, there is so much information but most important is this forum that i can see will be a great resource for me. I am grateful for any words of wisdom from folks who have gone through or are going through this process.

    • #12333
      Annette Cyr
      Participant

      Hi Frankie!
      Well, you are to be congratulated for being so aware of your body and so persistent with the doctors. If you had not, it may have been a completely different story by now – especially something on the bottom of the foot – not a place people normally look. Do you know if this was still classified on your pathology as superficial spreading melanoma (cutaneous melanoma) or was it another form of melanoma which is often found on the foot or under nails – acral lentiginous melanoma? It would be important to know that as the latter can be a bit more aggressive and problematic to treat as is is a rare form of melanoma – generally found more commonly in the dark skin populations.
      I am sorry you are having difficulty with your dermatologists – it is shameful if they are being dismissive – particularly now that you have a proven diagnosis. Unfortunately these days we are running into many derms and GPs that are not taking the appropriate time to thoroughly check patients – particularly those with high risk profile (sun damage, prior history, family history, medical condition that predisposes to melanoma, light hair/light eyes/ red hair, burns easily, heavily freckled or moled etc.). When you have a diagnosis, at a minimum you are to be seen by a dermatologist once a year for life. Many derms have busy practices – partly government’s fault as they restrict the number of derms and there are only 530 ish in the whole country for a population of 36 million. The other part is that derms now are focusing heavily, in some cases, on cosmetic procedures, which pays more and doesn’t allow time for other patients. That is not all derms of course – there are many out there that are highly skilled, caring professionals that do a great service for us all. But the pressures are there and we, as an organization, are seeing more and more complaints from patients just as you have indicated. It is crazy. At each annual appointment, the derm needs to take appropriate time and check you everywhere – scalp, feet, behind ears, private areas (butt too) – not time to be modest – and also use a dermatoscope to look at moles or lesions and take pictures of anything suspicious – or when in doubt take it out!

      Derms are usually the ones to do the biopsy and should be skilled enough. They need to do a proper one though – not a shave biopsy which can ruin the sample for pathologists ( unfortunately we hear of this often too),but a plastic surgeon can do it as well. If it means a delay, insist they do it as delay can create problems too. If you have a good surgeon then great that at least they are looking at it. Unfortunately in their training, not a lot of time is given to skin cancer, so there is going to be varying degrees of knowledge based upon what the physician has been exposed to. This does put us at a disadvantage as we put our faith in their hands. There is no reason for any of them to be dismissive and it is so hard for a patient to challenge that back and be persistent, but that is the reality.

      I hope to do some work in the near future on the issues patients are experiencing in this pipeline, just to get access to a proper diagnosis. Keep us posted on your biopsy results and do not hesitate to call if you need help. We also have some amazing patient support services if you find it challenging dealing with a diagnosis. Best,
      Annette – MNC

    • #12358
      Anonymous
      Inactive

      Thank you Annette for the response and information. I will try to be more vocal and persistent in the future to ensure i am being heard and my concerns acknowledged.

      I not so sure i am aware of my body, everyone keeps telling me that the sole of the foot is so often ignored and frankly i ignored it myself for 2 months after i spotted the “spot”. Then one day i did what every normal human does and asked google. Not always the smartest thing to do but in this case it prompted me to show my GP and the rest is history.

      I actually didn’t have a copy of the pathology reports so requested them today. It only states “melanoma in situ – no ulceration”. It also describes the tissue along with the cells etc…but no where does it states the type of melanoma. I will ask my surgeon when i go in for my follow up on March 17th.

      Thank you, again. i will most definitely update you on the biopsy results.

    • #12590
      Anonymous
      Inactive

      Hi:

      Just wanted to come on here to provide an update. The results of the 3 biopsies was that all 3 were atypical moles. The explanation i received was that these are the kind of moles that can turn into melanoma. And that people with a large number of these are at greater risk. We had a conversation regarding follow up treatment and that i need a good dermatologist. I voiced my concerns regarding the last 2 i saw and he will be referring me to someone in Mississauga who he feels will be attentive and thorough.

      In regards to the melanoma removed from the sole of my foot and the pathology, there was no classification on the pathology report he had. Not sure if this is normal or not that a classification on the mole was not done.

      Wishing everyone well,

      Frankie

    • #12592
      Annette Cyr
      Participant

      Hey Frankie,
      You definitely will need to be seen by a good dermatologist who can do a thorough skin check at least once a year. But you will still be the best at monitoring your skin. It is tough to look at some areas of the body like the back, and as we age our eyes are often not as up to the task of detecting small changes. If you have a partner or trusted friend that you can ask to take photos of the areas you cannot see, from the same distance each time, that may help to monitor your moles for any changes. People like yourself that have many – more than 50- are at increased risk. Some have a genetic issue that creates higher risk. I am glad you had those moles out and are going to be watched closely. Patients are the best at recognising changes in their bodies so you have to be an active partner.As far as the mole on your foot, you could always ask your derm to ask the pathologist if there was any differences in that mole that would indicate acral melanoma – that is a rare subtype of melanoma that normally is found on the soles of the feet or hands. It might be worth the inquiry. Chances are it isn’t but just because of the location it is curious.

    • #12639
      Anonymous
      Inactive

      I just wanted to jump in to the discussion re: doctors working together. It can certainly be overwhelming to deal with so many different specialists. In our case, it went like this: GP(original concern)->plastic surgeon(biopsy, then wide excision surgery)->surgical oncologist(SNB)->oncologist specializing in melanoma(follow-ups, explanation of staging, treatment etc)->dermatologist(full body check and follow-ups). I have to say that having doctors who work together and consult with one another is key. We seem to have lucked in to pairs of doctors who do this and are used to working as a team/in tandem. We never get conflicting information and they have all taken endless time answering questions and listening to concerns. @Frankie1966, is it possible to get a second opinion or find physicians who will listen to you?

    • #12698
      Anonymous
      Inactive

      Hi Annette:

      I called the dermatologist to find out about the subtype. The person on the phone wasnt of very much help. I told her i would like them to contact the pathologist to find out. She said she would but lets wait and see.

      blackj: You are lucky to have a team that is working together. It is what i am hoping to find. My surgeon has referred me to the one he recommends so lets hope this is the first step.

      Thank you hope everyone is having a great day!

    • #12699
      Anonymous
      Inactive

      Hi Frankie,
      My initial thought is that the dermatologist who was recommended by your oncological surgeon will be a specialist in oncological dermatology. Your new dermatologist should receive your pathology report in the referral chart and be able to provide you with the information you want. You should notice a markedly different “attitude” in your care from your new dermatologist.
      On a lighter note, my initial dermatologist who I was referred to and saw at JCC was not only excellent he was extremely handsome and impeccably dressed. Even his interns/residents were the same! It was momentarily awkward on my part sometimes, ha ha. I even mentioned this to his nurse once and she agreed she even shared with me that she noticed that many of his younger female clients would have obviously new undergarments at their appointments. If you indeed are being referred to Dr. Rosen be assured that he is excellent but warned he looks more like a television doctor than a real doctor ha, ha.

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