View Full Version : Mole biopsy came back as "moderate to severe atypia." In hysterics.
This is the most scared I've been in years. Every other time I've worried about something, test results would come back completely clear. This is the only time I've ever had anything come back abnormal and I'm truly in hysterics over it.
I had a new freckle on my finger that I noticed last April. It started off very small but kept growing, and I was terrified it was Melanoma. It was round and brown, but the fact that it was evolving made me go to the derm in November to get it looked at. He wasn't worried at all even though I told him it was growing, but he took it off for me since he saw how freaked out I was.
Once it was off, I completely got over it. Didn't think about it at all even as I walked out of the office. They said they'd call me with the results, but I was so sure then that it was nothing that I didn't wait by the phone.
Turns out I'd missed a few calls in December, and finally they sent me a letter in February saying they had my results and to call them. I completely freaked out. I called them back, and the nurse told me they had found atypical cells in the biopsy and to come back in to get it looked at and maybe get a wider excision. When I hung up, I had a complete screaming-on-the-floor meltdown. I had never been so scared in my life. I called back later to ask more questions because the nurse hadn't explained what that even meant, and she told me it was NOT cancerous but just atypical. She told me it was nothing to lose sleep over and that maybe if I left the cells for 1,000,000 years it might turn into something, but that it seemed unlikely. That calmed me down, and I was able to mostly function for a little while.
Well, I went to my followup the other day. The derm I saw was a different one from the first one I'd seen about the spot, and he was much more intense with horrible bedside manner. He fearmongered the hell out of me, told me crazy things like "we can't be certain it wasn't early evolving melanoma" which confused me because I thought they could tell it was benign from the biopsy?! Then he showed me pics of melanoma, which I'd already seen, and said, "This is what we worry about, because this can kill you." I wanted to scream at him and ask him why the hell he thought it was a good idea to talk like that when I'd told him the MOMENT he walked in that I have horrible anxiety. I was visibly shaking and already crying the moment he came in, and it's like he didn't even notice or care.
He said we'll have a wider excision where they'll take more skin and get clean borders. He said once we do that, I'll never have to worry about it again because it'll be completely gone. This was supposed to calm me down, but for some reason it didn't. I was so terrified by how poorly he'd explained everything and how concerned he was that I was breaking down. When he left the room, I burst into tears and asked the nurse, "Does he think it was cancer?" And she said no, and explained that atypical means a gray area between totally normal and cancer. For some reason this didn't help either. I don't like knowing I had anything on me that was abnormal. I don't like the uncertainty.
From all my research, I'd read that atypical moles aren't really that big of a deal and that melanoma typically evolves from normal skin, and that it's melanoma from the start. I read that it's very rare for them to come out of even atypical moles, and that kept me at bay for a while. But this derm has shattered all of that and I'm in pieces. I wish he had been gentler with me and explained things better instead of making this atypical mole, which apparently is super common, into a huge deal and make me feel like I'll get cancer in a week.
I had the worst panic attack of my life a few nights ago and wound up in the ER because I couldn't breathe. All of the worry from this stupid freckle culminated in that. It was 3 in the morning and they gave me a shot of Ativan. I had another attack yesterday from thinking about all this and had to take another Ativan. I haven't been on that drug since I was 19 and doing terribly, but at least I was worried about something that wasn't happening at all back then. This is actually real.
I go in the 21s for the wide excision. I have no idea how to handle this. I'm covered in spots and feel like I'll get melanoma at any moment and it'll be too late. All I've thought about for weeks is death and I can't take much more of it.
utrocket09
10-03-19, 20:01
This is the most scared I've been in years. Every other time I've worried about something, test results would come back completely clear. This is the only time I've ever had anything come back abnormal and I'm truly in hysterics over it.
I had a new freckle on my finger that I noticed last April. It started off very small but kept growing, and I was terrified it was Melanoma. It was round and brown, but the fact that it was evolving made me go to the derm in November to get it looked at. He wasn't worried at all even though I told him it was growing, but he took it off for me since he saw how freaked out I was.
Once it was off, I completely got over it. Didn't think about it at all even as I walked out of the office. They said they'd call me with the results, but I was so sure then that it was nothing that I didn't wait by the phone.
Turns out I'd missed a few calls in December, and finally they sent me a letter in February saying they had my results and to call them. I completely freaked out. I called them back, and the nurse told me they had found atypical cells in the biopsy and to come back in to get it looked at and maybe get a wider excision. When I hung up, I had a complete screaming-on-the-floor meltdown. I had never been so scared in my life. I called back later to ask more questions because the nurse hadn't explained what that even meant, and she told me it was NOT cancerous but just atypical. She told me it was nothing to lose sleep over and that maybe if I left the cells for 1,000,000 years it might turn into something, but that it seemed unlikely. That calmed me down, and I was able to mostly function for a little while.
Well, I went to my followup the other day. The derm I saw was a different one from the first one I'd seen about the spot, and he was much more intense with horrible bedside manner. He fearmongered the hell out of me, told me crazy things like "we can't be certain it wasn't early evolving melanoma" which confused me because I thought they could tell it was benign from the biopsy?! Then he showed me pics of melanoma, which I'd already seen, and said, "This is what we worry about, because this can kill you." I wanted to scream at him and ask him why the hell he thought it was a good idea to talk like that when I'd told him the MOMENT he walked in that I have horrible anxiety. I was visibly shaking and already crying the moment he came in, and it's like he didn't even notice or care.
He said we'll have a wider excision where they'll take more skin and get clean borders. He said once we do that, I'll never have to worry about it again because it'll be completely gone. This was supposed to calm me down, but for some reason it didn't. I was so terrified by how poorly he'd explained everything and how concerned he was that I was breaking down. When he left the room, I burst into tears and asked the nurse, "Does he think it was cancer?" And she said no, and explained that atypical means a gray area between totally normal and cancer. For some reason this didn't help either. I don't like knowing I had anything on me that was abnormal. I don't like the uncertainty.
From all my research, I'd read that atypical moles aren't really that big of a deal and that melanoma typically evolves from normal skin, and that it's melanoma from the start. I read that it's very rare for them to come out of even atypical moles, and that kept me at bay for a while. But this derm has shattered all of that and I'm in pieces. I wish he had been gentler with me and explained things better instead of making this atypical mole, which apparently is super common, into a huge deal and make me feel like I'll get cancer in a week.
I had the worst panic attack of my life a few nights ago and wound up in the ER because I couldn't breathe. All of the worry from this stupid freckle culminated in that. It was 3 in the morning and they gave me a shot of Ativan. I had another attack yesterday from thinking about all this and had to take another Ativan. I haven't been on that drug since I was 19 and doing terribly, but at least I was worried about something that wasn't happening at all back then. This is actually real.
I go in the 21s for the wide excision. I have no idea how to handle this. I'm covered in spots and feel like I'll get melanoma at any moment and it'll be too late. All I've thought about for weeks is death and I can't take much more of it.
Atypical moles mean nothing. My husband has had 20 moles removed half are moderate atypical. His largest moles he had excisions done as well. Within a few days he was back to normal. Was sore for a few days but that was all. They only do those to just make sure they got everything.
Exactly - I had fear over a mole about 6 months ago.
Atypical mole really just means its a bit different from the rest. Very, very rarely do they transform into anything sinister. I can't remember the exact statistics, but it was very low.
Sorry to hear your doctor had a bad bedside manner. This is all too common!
At least you're "in the loop" now, so your skin can be monitored more closely.
Good luck
Thank you guys. I just feel so angry at how he treated the whole thing. He had me describe the spot and I told him it had grown over a few months, and he shook his head and was like, "Oh, I don't like that at all." My whole body just went completely cold. It's a wonder how I didn't pass out, I was so worked up.
So the excision is a normal process? In my calmer moments I'm able to see it as a preventative thing, which my anxiety should be over the moon for, but I just keep feeling like I'm marked for cancer in my future. Doesn't help that I got about five new freckles since my appointment in November. :weep: He had a quick look at them during the followup and didn't seem concerned, just took some pictures, but I'm so worried that anything I'll get taken off in the future will be funky too.
utrocket09
10-03-19, 20:30
Thank you guys. I just feel so angry at how he treated the whole thing. He had me describe the spot and I told him it had grown over a few months, and he shook his head and was like, "Oh, I don't like that at all." My whole body just went completely cold. It's a wonder how I didn't pass out, I was so worked up.
So the excision is a normal process? In my calmer moments I'm able to see it as a preventative thing, which my anxiety should be over the moon for, but I just keep feeling like I'm marked for cancer in my future. Doesn't help that I got about five new freckles since my appointment in November. :weep: He had a quick look at them during the followup and didn't seem concerned, just took some pictures, but I'm so worried that anything I'll get taken off in the future will be funky too.
Yes they are a normal process. For my husbands they were so large he had to go to a plastic surgeon to have the rest removed.
I'm also annoyed that they didn't explain my pathology report at all but still gave me the papers. I tried reading it and looking things up but that only made me more anxious. There was something about a Melan. A test being positive but when I looked it up it said normal moles come up positive for that too and it's not definitive to diagnose melanoma? I feel like if it was melanoma that's what the report would have said, not just atypical...ugh, I hate this. I keep getting these big waves of panic and I'm so upset with the whole experience in the office, I feel like it's set me back years in my recovery.
I'm so sorry you went through this. I hate doctors with poor bedside manner, and it's especially terrible that he was so insensitive when you told him you have anxiety. It seems based on what the first doctor said and what the nurse said that you really have nothing to worry about. I've had doctors in the past that are just more doom and gloom than others. My old gyneocologist, when I got excited for my positive pregnancy blood test, looked at me deadpan and said "well, I don't like to celebrate until the baby is safely in your arms." :scared15: I mean, he's right, but it may not be the best opening line when someone finds out they're pregnant.
Since it's all upsetting you so much, maybe it would help to call the office and ask to speak with a nurse or even ask if you can get a call back from the original doctor you saw just to go over your worries. I know reassurance isn't always the answer when it comes to health anxiety, but you seem have been dealing very well with the reality of the situation until this encounter. I think it's fair to have someone you feel more comfortable with walk you through the test results, action plan, and future risk factors.
MJunderway
12-03-19, 22:42
Same thing happened to me and I'm at a higher risk with having red hair and a family history of skin cancer. Turns out that the dermatologist I had gone to was known to over-request biopsies and then do excessive follow up procedures. Our babysitter who lived in the neighborhood where the practice was located said that his nickname around town was "The Butcher"! But it's also helpful to know that there has been a shift in the last 20 years in dermatology to do more biopsies and over diagnose than in previous years. It's taken me a while to find a derm that I trust and since I've been going to that practice, it's been night and day. If you haven't done so already, you might want to find a new dermatologist.
Same thing happened to me and I'm at a higher risk with having red hair and a family history of skin cancer. Turns out that the dermatologist I had gone to was known to over-request biopsies and then do excessive follow up procedures. Our babysitter who lived in the neighborhood where the practice was located said that his nickname around town was "The Butcher"! But it's also helpful to know that there has been a shift in the last 20 years in dermatology to do more biopsies and over diagnose than in previous years. It's taken me a while to find a derm that I trust and since I've been going to that practice, it's been night and day. If you haven't done so already, you might want to find a new dermatologist.
From what I've read, it is standard of care to get a wide excision for a severely dysplastic mole or for a moderately atypical mole where they didn't get clear margins with the biopsy. It sounds, from her post, that they did not get clear margins and it could have been severely atypical...so....I don't think we should be scaring her off this doctor. Regardless of how he presented the facts, he is acting as dermatologists should.
Harper- in your shoes, I would feel comfortable with this. They are being very conservative and treating it like a melanoma in situ, and 99% + of those are cured with what is going to happen to you. Since you don't even have melanoma, they are assuring you never will and, as I said, this is how any dermatologist would deal with your path report. Hope you're not still freaking about this.
From what I've read, it is standard of care to get a wide excision for a severely dysplastic mole or for a moderately atypical mole where they didn't get clear margins with the biopsy. It sounds, from her post, that they did not get clear margins and it could have been severely atypical...so....I don't think we should be scaring her off this doctor. Regardless of how he presented the facts, he is acting as dermatologists should.
Harper- in your shoes, I would feel comfortable with this. They are being very conservative and treating it like a melanoma in situ, and 99% + of those are cured with what is going to happen to you. Since you don't even have melanoma, they are assuring you never will and, as I said, this is how any dermatologist would deal with your path report. Hope you're not still freaking about this.
I think that's what I've been freaking out about, that the treatment for an atypical mole is the same as a removal for melanoma. I keep conflating the two and thinking I have cancer because I'm getting a procedure done for people with skin cancer. Then again, lots of procedures overlap for benign things like atypical moles so...that might just be me overreacting.
I'm having a really hard time. I had to go to a walk-in mental health facility yesterday because I couldn't take it anymore. They prescribed me Cymbalta (which I've never tried) and clonazepam which I used to be on for a while with good results. I feel like I'm in the throes of a genuine nervous breakdown over this. I keep literally forgetting I don't have cancer and keep acting/feeling like I'm on borrowed time. It's very, very depressing and I'm struggling.
I won't back out of the appointment, because the derm said it's the best thing I could do for my health anxiety because I'll never have to think about it again after this.
I'm just used to all of my tests coming back completely clear. This is the first time anything has ever come back with anything noteworthy, and it's really shattered me, even if it's not cancer. It just makes me feel like that's where I'm heading.
I found some comforting information that I want to put here for anyone else going through this. It made me feel a little less crazy about this.
Can a dysplastic nevus turn into melanoma?
Yes, but most dysplastic nevi do not turn into melanoma (1 (https://www.cancer.gov/types/skin/moles-fact-sheet#r1), 3 (https://www.cancer.gov/types/skin/moles-fact-sheet#r3)). Most remain stable over time.
Should people have a doctor remove a dysplastic nevus or a common mole to prevent it from changing into melanoma?
No. Normally, people do not need to have a dysplastic nevus or common mole removed. One reason is that very few dysplastic nevi or common moles turn into melanoma (1 (https://www.cancer.gov/types/skin/moles-fact-sheet#r1), 3 (https://www.cancer.gov/types/skin/moles-fact-sheet#r3)). Another reason is that even removing all of the moles on the skin would not prevent the development of melanoma because melanoma can develop as a new colored area on the skin (2 (https://www.cancer.gov/types/skin/moles-fact-sheet#r2)). That is why doctors usually remove only a mole that changes or a new colored area on the skin.
Dysplastic Nevus
Is it cancer? No. A dysplastic nevus is more likely than a common mole to become cancer, but most do not become cancer.
How many people have dysplastic nevi? About 1 in 10 Americans—about 33 million people—have at least one dysplastic nevus (3 (https://www.cancer.gov/types/skin/moles-fact-sheet#r3), 4 (https://www.cancer.gov/types/skin/moles-fact-sheet#r4), 6 (https://www.cancer.gov/types/skin/moles-fact-sheet#r6)–8 (https://www.cancer.gov/types/skin/moles-fact-sheet#r8)).
The important thing to keep in mind is that atypical moles are noncancerous, and removing those with moderate and severe atypia reported on a biopsy may be recommended as a precautionary measure.
I'm so scared it's going to come back as melanoma this time. It was moderate to severe atypia on the biopsy, and that was back in November. I'm scared that I waited too long for the excision. It doesn't even matter to me that melanoma in situ doesn't kill anyone, I don't want a history of skin cancer at 26. What will that say about my future? I feel like I'd just get it again and again.
I'm sorry. I'm doing terribly. I've had to take a klonopin almost every day for the past week. I started Cymbalta but it isn't kicking in yet, it's only been a week.
I don't want to see this derm that fearmongered me last time and didn't care about my anxiety at all. I have no idea what other off the wall thing he's going to say this time that I'll obsess over. He treated me like a cancer patient, that level of urgency over an atypical mole.
Sorry for whining about this again, but I'm scared as hell and I'm dreading some phone call after telling me the margins aren't clear or that it came back as melanoma after all. I'm scared it was melanoma to begin with, just misdiagnosed as atypical or that it was too early to tell what it really was. I can't stop my thoughts from racing. I'm driving my girlfriend nuts going over this again and again.
There's no repigmentation in the scar tissue at least. That has to be good, right?
nomorepanic
20-03-19, 17:54
Hi
This is just a courtesy reply to let you know that your thread was merged with another of your threads.
Please when posting on similar topics add it onto your previous post rather than starting a new one.
It is nothing personal it is just to make it easier for people to follow your story and to give you advice as a whole.
utrocket09
20-03-19, 20:22
I'm so scared it's going to come back as melanoma this time. It was moderate to severe atypia on the biopsy, and that was back in November. I'm scared that I waited too long for the excision. It doesn't even matter to me that melanoma in situ doesn't kill anyone, I don't want a history of skin cancer at 26. What will that say about my future? I feel like I'd just get it again and again.
I'm sorry. I'm doing terribly. I've had to take a klonopin almost every day for the past week. I started Cymbalta but it isn't kicking in yet, it's only been a week.
I don't want to see this derm that fearmongered me last time and didn't care about my anxiety at all. I have no idea what other off the wall thing he's going to say this time that I'll obsess over. He treated me like a cancer patient, that level of urgency over an atypical mole.
Sorry for whining about this again, but I'm scared as hell and I'm dreading some phone call after telling me the margins aren't clear or that it came back as melanoma after all. I'm scared it was melanoma to begin with, just misdiagnosed as atypical or that it was too early to tell what it really was. I can't stop my thoughts from racing. I'm driving my girlfriend nuts going over this again and again.
There's no repigmentation in the scar tissue at least. That has to be good, right?
You have to let this go. Its aready been removed. They are just getting the rest of it.Time to move on to something else. Atypical moles mean nothing.
BrightPhoenix
21-03-19, 06:22
It seems like the main reason why they're doing these is to PREVENT what you're worried about. As much of a jerk as that derm was, it sounds like it was good that you came in and are having it dealt with. Don't worry, you should be fine. After all this I strongly suggest seeing a therapist because they are the ones trained to help you deal with these types of scares. I know it's really scary, but a therapist will give you someone you can work out your fears with and who will listen to you - you'll feel a lot better being able to vent all your frustrations about this derm with his bad bedside manner.
Take that Clonezapam. That stuff is a GODSEND when I get my health anxiety attacks.
Just got back from the excision. I took a klonopin ahead of time so I was able to match the derm's humor this time. In fact he was downright normal! They took some more skin and did a single stitch since it's on my finger and in an awkward spot, then did a weird cauterize thing which was gross since I smelled some skin burning. :scared15: But he was very chill and the nurse was too, so I stayed calm during the procedure, even joked that they could take the whole hand if they felt like it.
I asked him after if this is anything I need to be worried about in the meantime. He looked at me and said, "My philosophy is to not worry unless you have to. If you had to be worried, I'd tell you. Right now I'm telling you not to worry about this." That was pretty huge. And both him and the nurse said they'd be VERY surprised if the pathology results came back as anything besides atypical. They said these things almost always just reaffirm what they knew at the biopsy. So that helped a lot.
I'm forcing myself to believe them, because they sounded confident that I'd be just fine. Results should be in in a few days and I go back in a week to get the stitch out. I'm pretty pleased with how I handled it. Now I just have to see how I hold up these next few days waiting for the results.
Just got back from the excision. I took a klonopin ahead of time so I was able to match the derm's humor this time. In fact he was downright normal! They took some more skin and did a single stitch since it's on my finger and in an awkward spot, then did a weird cauterize thing which was gross since I smelled some skin burning. :scared15: But he was very chill and the nurse was too, so I stayed calm during the procedure, even joked that they could take the whole hand if they felt like it.
I asked him after if this is anything I need to be worried about in the meantime. He looked at me and said, "My philosophy is to not worry unless you have to. If you had to be worried, I'd tell you. Right now I'm telling you not to worry about this." That was pretty huge. And both him and the nurse said they'd be VERY surprised if the pathology results came back as anything besides atypical. They said these things almost always just reaffirm what they knew at the biopsy. So that helped a lot.
I'm forcing myself to believe them, because they sounded confident that I'd be just fine. Results should be in in a few days and I go back in a week to get the stitch out. I'm pretty pleased with how I handled it. Now I just have to see how I hold up these next few days waiting for the results.
Well done! So glad to hear it went well.
Well done! So glad to hear it went well.
Thank you! I'm still having some numbness in my fingertip today but massaging it helps break it up a little. No pain yet. Woke up feeling a little depressed with some intrusives but I'm trying to remember what the derm said and not obsess over the results in the meantime.
I’m really sorry to see your doctor didn’t handle that well at all! Atypical is a scary word when it comes to anything health related, but from my understanding it doesn’t mean a “grey area” so much as they’re a little wonky, but they’re fine. I had a very atypical mole on my pantyline that I was CONVINCED would be bad: i’d had it in my youth, but it looked much darker than I remembered. The results were fine, it was just atypical!
I also had a tiny tiny freckle pop up on my toe last year. Given that it was new, it freaked me out even more. My dermatologist wanted to shave it a bit to test, but I opted for removal... never heard back about that one, so likely just another odd one!
I’m glad to hear you went through with the follow up for your own peace of mind. It’s really hard to do in those times where the fear is overwhelming, but in the end it’s worth it!
I know this has been "put to bed" now, but I want to add a comment with a link to article debunking the "pre-malignant mole" worries (http://According to the latest research, which I have blogged about before here, there is probably no such thing as an identifiable ‘pre-malignant mole’.So, with respect to Miss Ravenscroft, she appears to have picked up a populist idea which is scientifically established to be wrong. The idea that funny looking moles need to be cut out to stop them developing into cancer is mistaken, and can lead to needless fear and surgical scars.). This is written a well versed doctor on the subject, who teaches the "art" of dermoscopy to GPs across the UK.
The important part of the article:
The young lady said, and I quote, ‘I realised if I didn’t have them taken off I could end up with skin cancer’. This amounts to an assertion that these moles were known to be pre-malignant.No evidence is provided to support this statement, and I am concerned that it may lead to needless fear. I am seeing patients in my NHS clinic who have become terrified witless about trivial moles after something they have seen on line.
According to the latest research, which I have blogged about before here (https://dermoscopy.wordpress.com/2015/10/20/harald-kittler-on-the-myth-of-dysplastic-naevi/), there is probably no such thing as an identifiable ‘pre-malignant mole’. So, with respect to Miss Ravenscroft, she appears to have picked up a populist idea which is scientifically established to be wrong. The idea that funny looking moles need to be cut out to stop them developing into cancer is mistaken, and can lead to needless fear and surgical scars.
And the article he linked to:
Professor Kittler explains why we now have good evidence, not least from digital monitoring, that ‘dysplastic’ naevi are NOT precursors to melanoma. They are just slightly funny looking moles. His team have digitally monitored some 30,000 such moles and none has turned into a melanoma. A better term would be ‘atypical’. Listen to him for the full picture.
So this information is not only for your benefit, but for anyone else who may find themselves in a similar situation
redmysterygurl
08-04-19, 04:18
I have so many and have had 3 taken off that was atypical. Doctor said most of the time they never develop into anything.
Double_Rainbow
13-04-19, 02:51
Anyone who biopsy their moles will eventually find at least one which is atypical. I myself had 2 moderately atypical taken out, one with wide excision. My doc didn't even want to excise but I pushed for it so they did. It's no big deal.
Atypical moles are a relatively new concept, that evolved with the increased use of skin biopsies. People didn't know what to make of it so they empirically linked it to melanoma. But several decades of research showed that there is very little if any link between atypical moles and melanoma. So it gets debunked more and more now. Atypical moles have NO invasive potential. Once it is all cut out, it is gone and will not come back. So dont worry. You are ok.
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