Severely Atypical Mole with Regression: Time to Worry
If you have a severely atypical, irregular or dysplastic mole that’s showing signs of regression (new areas of milky-white color), this is very worrisome for melanoma.
A white “spot” in a mole isn’t always cancerous, and may be a harmless hair follicle.
It’s very important to closely monitor any areas of even a normal-looking mole that appear to be disappearing — or seemingly filling in with a dull white or the color of one’s baseline skin tone: in other words, regressing.
Have you been told you have dysplastic moles?
These moles tend to be larger than average, often larger than the diameter of a pencil eraser, and usually are asymmetrical, lopsided, “odd” or “funny” in appearance.
Regression in Moles: Can Be Normal, Can Mean Melanoma
“Regression is a phenomenon in which a mole appears to be fading or disappearing, often in an irregular manner,” says Kara Shah, MD, an adult and pediatric dermatologist and founder of Kenwood Dermatology in Cincinnati, OH.
“To the naked eye, regression typically appears as one or more areas within a mole that are lightening in color,” continues Dr. Shah.
“Complete loss of pigment in some areas may result in areas that appear milky white in color.
“Regression is an immune-mediated phenomenon that results from activation of a type of white blood cell called a T-lymphocyte.
“It is considered part of the body’s innate cancer-surveillance system.
“Although benign moles may sometimes gradually and uniformly fade as part of a phenomenon called a halo reaction, signs of regression in a mole that appears atypical are concerning for melanoma.
Halo nevus (mole)
“If such a mole is biopsied and the dermatopathologist notes that the mole is severely atypical or dysplastic, the areas of regression may represent an area of regressing cutaneous melanoma.”
If you have an irregular or odd looking mole that has recently begun showing signs of regression – you should promptly make an appointment with a dermatologist.
Do not settle for a naked-eye exam. The dermatologist should use a handheld lens (dermatoscope) to inspect the mole.
If the doctor says that the mole appears to be atypical or dysplastic, and that there’s signs of regression, it should be biopsied.
In fact, the development of new areas of white in even an otherwise normal-appearing mole may represent areas of regression suspicious for melanoma.
Malignant regression in any mole, for that matter, will appear in specific areas rather than causing a diffuse, evenly distributed regression.
When the entire mole seems to be fading evenly throughout, or diffuse fading – this “can be a sign of natural involution of normal melanocytic nevi, which is common in the aging population but can be selectively noted in younger persons and is generally a benign and harmless phenomenon,” says Dr. Shah.
Mole with Regression from Melanoma Is More Dangerous than Typical Melanoma
“If the T-lymphocytes have been mobilized to destroy melanoma cells as evidenced by areas of regression, it may make it more difficult to identify the melanoma on the skin, as some of the visual cues (e.g., brown or black areas within the melanoma) have been erased,” says Dr. Shah.
Consequently, diagnosis may be delayed.
What is a better description of an atypical mole with regression?
This would be “parts of it are disappearing” rather than “it’s fading.”
Dr. Shah is triple board certified: general dermatology, pediatric dermatology and general pediatrics. Her special interests include melanocytic nevi (moles), melanoma, psoriasis, acne, atopic dermatitis/eczema, hair and nail disorders, birthmarks and genetic skin diseases.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Image Sources
blog.melanomaeducation.net/melanomas-with-no-identified-primary-site/
British Journal of Family Medicine, Sept. 13; bjfm.co.uk/melanocytic-lesions-effective-management-in-primary-care-part-2
http://blog.melanomaeducation.net/melanomas-with-no-identified-primary-site/
Can Melanoma Cause Weird Feelings in a Mole?
That one particular mole, or maybe several of them, are generating weird feelings. Could this mean melanoma?
This isn’t about itching. It’s about weird sensations that seem to be coming from a mole that’s gotten your attention lately.
If you’ve already been diagnosed with melanoma, you may be at risk for noticing strange feelings from other moles.
“In general, melanoma does not produce any symptoms in the skin such as pain or itching, although rarely these symptoms may be noted,” says Kara Shah, MD, an adult and pediatric dermatologist and founder of Kenwood Dermatology in Cincinnati, OH.
Even though it’s an uncommon sign of melanoma, an itchy or painful mole should never be ignored, because melanoma CAN cause these symptoms.
“While any mole that is painful, itching or bleeding should be evaluated by a dermatologist, if the mole itself appears normal with none of the worrisome features for melanoma, it does not need to be removed,” says Kara Shah, MD, an adult and pediatric dermatologist and founder of Kenwood Dermatology in Cincinnati, OH.
What’s happening when someone notices odd or weird sensations coming from a mole?
As mentioned, a previous diagnosis of melanoma can put a person at risk for these perceptions.
Dr. Shah explains, “Receiving a diagnosis of melanoma can be a frightening experience, and this may result in increased anxiety and concern for the development of additional cutaneous melanomas.”
The anxiety can play tricks on the patient’s mind. There was the case of a man who’d been diagnosed with a single melanoma.
Soon after, he became convinced that about 20 additional moles were generating “weird feelings.”
Suspecting that they were cancerous, he requested removal of all of them. Every one came back benign.
“However, as the majority of moles never develop into melanoma, removal of otherwise benign-appearing moles is not recommended,” says Dr. Shah.
Anxiety About Getting Another Melanoma
Dr. Shah says, “Strategies that can be helpful in reducing anxiety surrounding melanoma in someone with a previous diagnosis include periodic skin examinations by a dermatologist and use of mole mapping and digital dermascopy to document and monitor existing moles.”
Worrisome Features of a Mole
• Increase in size
• Change in shape or texture
• Change in color or darkening
• Appearance of tiny bumps on the surface
• Any other change, such as a once-smooth border is now jagged.
• Appearance of tiny “satellite” moles near it
• Unexplained bleeding
• Oozing or crusting
• Center of the mole is disappearing
• A new bump that looks like a pimple but won’t go away
• A new, rapidly growing nodule (bump)
Any one of these signs does not automatically mean melanoma.
For example, what you thought was a mole all along might actually be a benign skin growth called a seborrheic keratosis. But have your dermatologist make this diagnosis; don’t assume.
Seborrheic keratosis
Furthermore, melanoma simply does not cause “weird feelings” or strange sensations to come from a mole.
Serial digital dermoscopy is an excellent way to track your moles over time.
Dr. Shah is triple board certified: general dermatology, pediatric dermatology and general pediatrics. Her special interests include melanocytic nevi (moles), melanoma, psoriasis, acne, atopic dermatitis/eczema, hair and nail disorders, birthmarks and genetic skin diseases.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/Africa Studio
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Can a Melanoma Survivor Live 30 Years?
If you’ve been diagnosed with stage IV or even stage III melanoma, you’ll likely be wondering if you’ll be alive 30 years from now if you’re middle age or younger.
“In general, survival rate statistics for melanoma are generally calculated at five years and 10 years after initial diagnosis,” says Kara Shah, MD, an adult and pediatric dermatologist and founder of Kenwood Dermatology in Cincinnati, OH.
The five-year survival rate for metastatic melanoma is only four percent, according to the National Cancer Institute Surveillance, Epidemiology and End Results Program.
“Stage IV melanoma involves distant metastasis to other body organs or to distant areas of skin,” says Dr. Shah.
For local disease (both stage 0 and I) the five-year survival is 84 percent.
“While melanoma is unlikely to recur after more than 10 years since diagnosis, it does recur in a small minority of patients (one study documented late recurrence in 6% of patients),” says Dr. Shah.
Two Big Questions
How many people out there walking around were diagnosed with melanoma at least 30 years ago?
How many were diagnosed with stage IV melanoma 30 years ago?
“Melanoma survival is correlated with the stage at diagnosis,” says Dr. Shah.
Melanoma
“Stage 0 melanoma, or melanoma in situ, has the best survival prognosis — as it is defined as very early melanoma confined to the superficial component of the skin.” That would be the epidermis.
The five year survival for in situ is over 98 percent. We can deduce that most 30-year survivors of melanoma were diagnosed in the early stage.
Dr. Shah continues, ‘While stage IV melanoma, in which there is distant metastasis of the melanoma to other body organs such as the brain, lungs or liver, has the poorest prognosis.
“Data related to 30-year survival rates is rarely published.
“It is important to note that the treatment paradigm for cutaneous melanoma continues to evolve, and with the recent advent of targeted therapies for melanoma, survival rates have been increasing.
“Most data on survival rates such as that compiled by the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) program use a five-year survival endpoint.”
30-Year Survival Rate for Children vs. Adults
Dr. Shah explains, “With regards to prognosis and age at diagnosis, data suggests that in general, survival statistics for pediatric melanoma mirror those for adults when matched for stage.
“In addition, children are more likely than adults to develop a type of mole called a Spitz nevus that can be misdiagnosed as a melanoma.”
Spitz nevus
This can skewer data for survival rates, even though the number of Spitz nevi that have been mistaken (and hence “treated”) for melanoma is not known.
So can a melanoma survivor live for 30 years?
Yes. It’s just that the statistics for “30-year survival rate” are not known, because the endpoints are either five years or 10 years.
It’s impossible to know how many people in the U.S. are 30+ year survivors of melanoma, let alone a particular stage.
The biggest predictor of whether or not a melanoma survivor will be alive 30 years after diagnosis is likely the stage of the initial disease.
There is no registry for 30+ year survivors of any stage of melanoma.
In this day and age, we can assume that somewhere in cyberspace is a cancer forum in which a 30-year melanoma survivor has posted. Or perhaps they have a blog.
Another way to know they’re out there (but without knowing their numbers) is by personally knowing one.
If you’re a melanoma survivor who’s scared you won’t be around 30 years from now, you should – as all survivors – commit to aggressive surveillance of your skin and never let your guard down.
It will also help to do everything possible to prevent heart disease, high blood pressure and stroke.
There’s no way to know how many melanoma survivors died of cardiovascular disease instead – people who could have lived to at least that 30-year mark had they not developed unrelated illnesses that shortened their life. Or gotten into a fatal car accident for that matter.
Here are more survival statistics from the SEER Program. The overall five-year survival rate of 92.2 percent includes ALL stages of disease.
Why isn’t there any data for 30 years out?
The median age of diagnosis, being 65, is very important to consider when wondering why there’s no data on 30 year survivals.
The vast majority of all 65-year-olds will not be alive 30 years later.
In order for research to be accurate about 30-year survival rates for this skin cancer, the tracked patient base would have to be young enough such that living another 30 years would fall well within normal life expectancies.
Cause of death of patients who died within that timeframe would also have to be tracked, since over a 30-year period, there are so many different potential causes of mortality including the No. 1 cause in the U.S.: heart disease.
Final Point to Consider
Current survival statistics are based on previous populations going back at least five years, and do not apples-to-apples reflect the next five, let alone 10, years of newly diagnosed cases of melanoma.
Dr. Shah is triple board certified: general dermatology, pediatric dermatology and general pediatrics. Her special interests include melanocytic nevi (moles), melanoma, psoriasis, acne, atopic dermatitis/eczema, hair and nail disorders, birthmarks and genetic skin diseases.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
Top image: Andrey_Popov
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