Is it Melanoma or a Benign Mole? It Depends on Who You Ask.

To follow up on this post: the pathology report indicates all the affected lesion was removed and I have been given a clean bill of health. I’ll be monitored by a dermatologist. But the news could not be better.

An article on “diagnostic drift” today in the New York Times sheds light on a personal experience I’ve had the last month. Four weeks ago I underwent a biopsy for an unusual looking mole. The pathology report came back indicating it was melanoma in situ, a malignant lesion. I had skin cancer. A form of cancer that is successfully treated but which in later stages can be fatal. This is not exactly the kind of news that makes your day.

I was first referred to Fort Worth Dermatologist Dr. Peter Malouf, then to a surgical oncologist and after a ten-day wait marked by anxiety, questions and numerous visits to the Mayo Clinic webstite and WebMD, I heard from the oncologist that a second pathology reading indicated the mole was more likely a melanocytic nevus, a benign mole. According to this interpretation I did not have cancer. Never the less, he said, the chances this mole could develop into a malignancy were good and it needed to be removed.

This is the diagnostic drift referred to in the study highlighted in the article–the growing tendency of some physicians to diagnose benign moles as malignant cancers.  The reasons are discussed in the article. What the article does not discuss is the dilemma of the patient. After having the bejeebers scared out of you, how do you evaluate such discrepancies? To the patient it’s more than an academic reading of the data. Regardless of the second opinion, the diagnosis that stuck in my mind is the first. I had cancer or I would get cancer.

These conflicting opinions presented me with several issues, not all of them related to health. I tend to keep my own counsel on such matters and would have preferred not to make this health condition public. However, given the earlier interpretation, I agreed with the oncologist that the lesion should be surgically removed. As it happened the only surgical date available fell on the same day as a meeting of the board of directors of our organization. I could not leave a meeting of my own board of directors without providing a good reason, so I told them about the situation. They were understanding and supportive.

And I cancelled attendance at another meeting out of town out of concern for hauling and lifting luggage with an incision on my shoulder. So now the word is out.

The surgery was uneventful. I am surprised at the length of the incision (six inches). It’s considerably longer than I expected, but the surgeon said he believes the excision removed all the affected tissue and the prospects for a positive outcome are quite good. I’ll get that pathology report on Thursday.

Whatever it says, I’m convinced we did the right thing. And I learned an important lesson. You have to arm yourself with knowledge from reliable sources. You have to ask questions. You have to assert yourself into the process. And you have to balance your fears against objective information and keep your head in the conversation. This isn’t easy but it’s necessary in order to manage your own care.

It falls to the patient to swim through the cross currents of diagnostic drift.

3 Responses to “Is it Melanoma or a Benign Mole? It Depends on Who You Ask.”

  1. Dale October 1, 2009 at 2:12 pm #

    So, did you get that report yet?

    • Larry October 2, 2009 at 7:28 am #

      Hi Dale,
      Yes. I got the report late yesterday. All good. Affected tissue removed. Follow up with dermatologist. Great outcome. Thank you for your concern.
      Larry

  2. Dale October 3, 2009 at 9:50 pm #

    Excellent news, Larry. Good to hear.

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