Patient's Query
Hello doctor,
I have a query regarding a spot on my back. I took some pictures with a digital microscope. I would like to know whether it is a mole or melanoma. My weight is 200 pounds. The images were taken with a common USB microscope connected to a computer. The spot measures around 0.5 mm (half a millimeter). I am attaching the pictures.
Kindly advise.
Hello,
Welcome to icliniq.com.
I understand your concern.
Thank you for sharing the pictures (attachments removed to protect the patient's identity). I would like to ask a few questions before giving my opinion.
How long has this spot been present?
Have you noticed any recent changes in color, texture, or ulceration?
There appears to be some oozing in a few photographs. Is that present?
Have you applied anything to the area?
Are there any symptoms such as pain, itching, or burning?
Also, please send photographs that are neither too close nor too far away. Based on the available images, it does not appear to be a common benign melanocytic nevus (mole), as there seems to be color variation and irregular margins. Please get back to me with the answers for further evaluation.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you. I do not know how long it has been there, as my girlfriend noticed it. There is some oozing because I scratched it intentionally, thinking it was something else. There is no pain, itching, or burning. Could it be melanoma? I am attaching more pictures for your reference.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Based on the photographs (attachments removed to protect the patient's identity), it does not look like melanoma. It appears to be an atypical nevus, also known as a dysplastic nevus. These are generally benign (harmless) lesions. However, having multiple atypical nevi may be associated with a slightly increased risk of developing melanoma.
An individual atypical nevus has a very small chance of progressing to melanoma. I advise taking photographs of it once a month to monitor for any changes in color, shape, or surface characteristics. A biopsy is not recommended at this time, but it should be considered if any of the above changes occur. For now, continue observation and maintain photographic documentation.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you. Yesterday, you mentioned that, based on the pictures, it does not appear to be a common benign melanocytic nevus because of the color variation and irregular margins, and I became very worried because it did not seem benign. I am attaching a picture that I took this morning.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
There is not much to worry about at present. A common nevus is also referred to as a benign melanocytic nevus. An atypical nevus is also benign. However, the presence of multiple atypical nevi may suggest a slightly increased risk of developing melanoma.
At present, the color variation and mildly irregular margin favor an atypical nevus. However, the size appears to be less than 0.5 cm, which favors a common nevus. I also understand that there are no multiple similar lesions.
For now, continue observing the lesion and take photographs once a month to monitor for any changes.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you.
This is the only lesion of this type. The oozing occurred because I scratched it hard intentionally, thinking it was something else. It is very small and measures less than 0.5 cm.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
That is why there is nothing to worry about at present. Continue observing the lesion regularly, preferably once a month. A skin biopsy is not recommended at this stage.
Also, scratching the lesion will not help and may only irritate it further. Which digital microscope did you use for the close-up images?
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you. I used a digital microscope with x4 or x6 zoom that I purchased online. I consulted two dermatologists.
The first dermatologist said that the area had been scratched, making it difficult to determine whether it was melanoma or a regular mole. The doctor also mentioned that if it were cancerous, it would be easy to remove because the size is around 0.2 mm.
The second dermatologist said that there is nothing to worry about because the lesion is symmetrical, and the color difference may simply be due to one area being brown and the rest black. She also advised removing the mole for future purposes. She took a picture of the mole, and the red areas are due to my scratching.
I am scared that it may be deep, spread throughout my body, and cause death. Based on previous photographs, I do not think it has been present for the last five years. If it has been present for that long, the size has remained the same, and it has not grown. The size measures around 0.1 mm.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Please do not worry too much, as it is most likely a benign lesion. If you remain concerned and have the option to remove it, you may proceed with removal. It is generally a simple procedure that takes approximately five to ten minutes.
I hope this was helpful
Thank you.
Patient's Query
Hello doctor,
Thank you. One last question. The mole measures about 1 mm. Could this be nodular melanoma? If it is cancerous, how deep could it be?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Melanoma can occasionally measure only one to two mm in diameter. However, lesions of this size are generally not deeply invasive. The average thickness of melanoma reported in some studies is around 0.7 mm.
You cannot classify this lesion as nodular melanoma based solely on its size, as nodular melanomas are usually larger and raised. Very small melanomas are sometimes referred to as micromelanomas.
If removal is performed, a simple punch excision using a 4 to 5 mm punch is generally sufficient to remove the lesion completely.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. The redness is what worries me. I am concerned that it might be a spreading melanoma.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
Even if melanoma of this size occurs, it is usually not deeply invasive. Therefore, do not worry excessively. Since the redness may also be related to scratching, proceed with the planned removal and histopathological examination for confirmation.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. I have booked an appointment for next Friday to have it removed. After removal, the mole will be sent for examination. I will keep you updated.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
That is good. Since you are worried about the mole, having it removed and examined is a reasonable approach. Please share the reports once they are available.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you. I read an article that states, Despite an SLN (sentinel lymph node) positivity rate of 16.5% overall, substantial heterogeneity of risk exists among patients with intermediate-thickness melanoma. Most patients with melanoma between 1.01 and 1.5 mm have a risk of SLN positivity similar to that of patients with thin melanomas.
Do I need an SLN (sentinel lymph node) biopsy if the lesion measures 1 mm?
What does this mean?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I understand your concern.
The first question is whether the lesion is actually melanoma. That can only be confirmed through a biopsy. The thickness mentioned in the article refers to the depth of melanoma measured on histopathological examination and not to the diameter of the lesion seen on the skin.
Therefore, the first step is to undergo a punch skin biopsy. If the lesion turns out to be a common nevus without any signs of malignancy, then no further evaluation, including an SLN (sentinel lymph node) biopsy, is required.
I hope this was helpful.
Thank you.
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