Q. Is this growing spot on my face a young melanoma?

Answered by
Dr. Ashwini V Swamy
and medically reviewed by iCliniq medical review team.

Hello doctor,

I recently had a melanoma in situ removed from my left middle finger knuckle. This has caused us to look more closely at other areas on the body. There is a small spot that was not there four months ago under my left eye. I started seeing it in photos after that faintly. It is now more defined and a lot easier to see in photos. It is still only about 2 to 3 mm and pretty faint. The dermatologist looked at it and said it was a bit raised compared to the other spots that looked like sun spots. She then froze all three. I am concerned this growing spot is a very young melanoma (since it is growing). It is been three days and the scab already peeled off and it seems to still be there (although that could be irritation from the freezing). How long do I need to go back and have it biopsied to know? I can send photos if needed.

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Dr. Ashwini V Swamy

MBBS., MD- DERMATOLOGY, VENEREOLOGY, LEPROSY
Dermatology Venereology

Hello,

Welcome to icliniq.com.

I saw your clinical pictures (attachment removed to protect patient identity).

In your recent picture, the lesion looks like seborrheic keratosis (harmless), it looks rough and raised. I cannot confirm what it is with this picture. I am sorry dear, the picture becomes little blurry when I try to zoom it, to appreciate finer features.

I am very sure your dermatologist would have looked at the spot with a dermoscope. With dermoscopy, the dermatologist can make out abnormal changes that are concerning.

Even if it is doubtful feature leaning towards melanoma, your dermatologist would have done a shave biopsy to rule out that minimal possibility.

After cryotherapy, the area becomes dark, it scabs and falls off after five to seven days.

I can understand your concern as you had a melanoma in situ removed recently.

Observe the treated spot for another week, allow the spot to heal completely. After a week, if you feel it is still there, then you can undergo shave biopsy which would say precisely what it is.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

Hello doctor,

Thank you for your quick and thoughtful reply. Since the melanoma diagnosis, I have had a hard time looking at any spot that grows like this. She did look at it with the special derm tool to look closer. Can I ask a few questions?

  1. Can a seborrheic keratosis appear so quickly? (Few months)
  2. I have other similar looking spots on my face, but they are not rough or raised. Is it normal for a spot like this to be different like that than the others?
  3. If it is melanoma in early stages, will it still appear that way on a biopsy even if it was previously frozen?

I had shown my melanoma spot to two dermatologists and when I still did not feel good about it, I saw a third and he took it. It was small, had clear borders, symmetric, and was only one color. The only strange thing was that it just looked very different than any other freckle and was growing and getting darker over time (I attached a photo). It is hard now as I am very afraid of every other spot on my body and do not want anyone to overlook a bad spot like the last time. I am just really scared.

Dr. Ashwini V Swamy

MBBS., MD- DERMATOLOGY, VENEREOLOGY, LEPROSY
Dermatology Venereology

Hello,

Welcome back to icliniq.com.

Let me address all your concerns, one by one. Can a seborrheic keratosis appear so quickly? (Few months) - Yes, it can appear over few weeks to months. These are also called age spots usually seen in adults and elderly, very harmless. I mentioned seborrheic keratosis because it was appearing raised, and little rough in that picture.

I have other similar looking spots on my face, but they are not rough or raised. Is it normal for a spot like this to be different like that than the others? Lentigines or sun spots, freckles are very common in fair type 2 skin people. If the spot is constantly under friction like rubbing, wearing eyeglasses, with pressure on those spots, it can become slightly thick and appear raised.

If it is a melanoma in early stages, will it still appear that way on a biopsy even if it was previously frozen? A pathologist will be able to see cancerous features even after cryotherapy if the spot is still there. After the biopsy, if there are no cancer cells that means it was not a melanoma or it is totally gone. There are staining methods where they can find even the slightest cancerous change in the tissue. A pathologist will be very cautious while seeing the biopsy if the history of previous melanoma has been provided to him.

Melanoma in situ is the early stage cancer, they have caught it and removed it with wide surgical excision. It is good to be cautious about any similar spots, new moles, changes in the existing mole, like:

A- Asymmetry.B- Border changes/Bleeding.C- Color change (darkening).D- Diameter changes (enlarging).

I can make a clinical diagnosis with what appears on this picture, but any cancerous feature needs to confirmed by biopsy. Allow a week to pass, so that it heals. See if the spot is still there. If yes, then you can go for shave biopsy (minimal pigmentation/scar from shave biopsy).

Hope I have answered your concerns to the best of my knowledge.

For more information consult a dermatologist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist

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