Dr. Dilip Kumar Meena
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have a query regarding a spot I have on my back. I took some pictures with a digital microscope. I need to know whether it is a mole or it is a melanoma. My actual weight is 200 pounds. Images were taken with a USB common microscope with a PC. The size measures around 0.5 mm, half a millimeter. I am attaching the picture. Kindly give your opinion.
Hello,
Welcome to icliniq.com.
Thanks for sharing the pictures (attachments removed to protect the patient's identity). I want to ask a few things before giving my opinion. What is the duration? Any recent change in color, texture, or any ulceration? It seems there is some oozing in few photos. Is it there? Have you applied anything? Any symptoms like pain, itching, or burning? And please send some pictures which are not from so far or so close. I mean somewhere between the two extremes you have sent. Whatever I could see in the pictures, it is not a benign melanocytic nevus, as the color variation and irregular margins can be noticed. Please get back with the answers for further help.
Patient's Query
Hello doctor,
Thank you. I do not know the duration, as my girlfriend figured it out. There is some oozing as I scratched it on purpose because I thought it was something else. There is no pain, no itching, and no burning. Is it melanoma? I am attaching pictures for your reference. Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
It does not look like melanoma (attachments removed to protect the patient's identity). It is an atypical nevus, also known as dysplasia nevus. They are benign (harmless) conditions as such, but the increasing number of these nevi indicate an increased chance of the development of melanoma. An individual atypical nevus itself has a very tiny chance of progressing to melanoma. I advise you to serially photograph it once every month or so to look for any changes in color, shape, or surface. Although biopsy is not suggested at this moment, you should get it done if there are changes in the future which I mentioned above. For now, observe and maintain photographic documentation. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. Yesterday you told me, " Whatever I could see in the pictures, it is not a benign melanocytic nevus, as the color variation and irregular margins can be noticed," and I got really worried about not being benign. I am attaching the picture I took this morning. Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
There is not much to worry about at present. It is just that common nevus is sometimes called a benign melanocytic nevus. Atypical nevus is also benign, but they are multiple, then they might be suggestive that the person has a higher chance for melanoma development. Right now, just the variegated color and a bit of irregular margin are in favor of atypical nevus, but the size looks less than 0.5 cm, so that is in favor of common nevus. Also, I believe you do not have multiple lesions like these. For now, just observe and look for any change once a month or so with photographs. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. This is the only lesion like that, and the oozing was from hard scratching on purpose because I thought it was something else. It is less than 0.5 cm, very small. Kindly guide me.
Hi,
Welcome back to icliniq.com.
That is why nothing to worry about as of now. Just keep observing on a regular basis, like once a month or so. Skin biopsy is also not recommended for this. And scratching will not help it, as you know now. Which digital microscope did you use for the close-ups? I hope this was helpful.
Patient's Query
Hello doctor,
Thank you. The microscope used was X4 or X6 zoom (it is a cheap item bought by online shopping). Now I went to two dermatologists. The first one told me the area is scratched, so it was hard to tell if it is a melanoma or just a regular mole and also told me if it is cancerous, it will be easy to remove as the size is around 0.2 mm very small. The second one told me there is nothing to worry about and the shape is symmetrical, and the color does not matter as the area might be brown and the rest black. She also told me cancerous or not, the mole needs to be removed for future purposes. She also took a picture of the mole (red areas are from hard scratches by myself). I am scared, thinking it will be deep and spread to my body and die. I think from previous pictures, this was not on me for the last five years. If the mole has been there for the past five years, the size stayed the same and never grown. Size measures around 0.1 mm. Kindly guide me.
Hi,
Welcome back to icliniq.com.
Please do not get worried as it is likely a benign lesion only. And if you are still this worried and you have an option to get it removed, please get it removed. It is hardly a 5 to 10 minutes procedure. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. One last question the mole is size 1 mm. Can this be a nodular melanoma? Or if it is cancerous, how deep can it be? Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
It can be 1 or 2 mm in the case of melanoma. But its thickness is not deeper than a few mm, the average being 0.7 mm in some studies. So if you get it removed, it will be gone completely. You cannot call it nodular melanoma as that is more than 6 mm in size. Some call them micromelanomas. In any case, a simple punch excision with a 4 or 5 mm punch will be sufficient to remove it completely. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. The redness is what is worrying me. I am worried it might be a spreading melanoma. Kindly help me.
Hi,
Welcome back to icliniq.com.
Melanoma of this size, even if it is not rare, is not deep. So do not get so worried and get it removed. I hope this was helpful.
Patient's Query
Hi doctor,
Thank you. I booked an appointment next Friday to get it removed. After that, the mole will be sent out to be checked. I will keep you updated.
Hi,
Welcome back to icliniq.com.
Thats great, when worried about the mole, you better get it removed. Please get back with reports.
Patient's Query
Hi doctor,
Thank you. An article says, "despite an SLN positivity rate of 16.5% overall, substantial heterogeneity of risk exists among patients with intermediate thickness melanoma. Most patients with melanoma between 1.01–1.5 mm have a risk of SLN positivity similar to that in patients with thin melanomas". Do I need an SLN if the size is 1 mm? And what does this mean? Kindly guide me.
Hi,
Welcome to icliniq.com.
The question is, is it melanoma. That confirmation on biopsy can only necessitate the SLN (sentinel lymph node) biopsy. The thickness you read here is not the diameter, it is the thickness of melanoma on histopathological examination. So the first thing is to go for a punch skin biopsy, and if it is a common nevus without any sign of malignancy, then no further action is required. I hope this was helpful.
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