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Thread: What do I do?

  1. #1
    Newbie New User
    Join Date
    Nov 2016

    What do I do?

    Hi all,

    I went to my GP with a lump on my ear and he said he would not treat it because it was a little advanced and referred me onto a Skin Cancer Specialist which was a little concerning.

    Went for the appointment today and it was an aging specialist who said he wanted to take a sample and send it for pathology.

    In the past, my GP has simply cut out the offending part and then sent it for Pathology.

    This specialist wants to take out half of it and send it for testing.....

    Is this normal?

    What worries me is his age and the way he explained the need to do this 50% procedure - He said it is like walking a Small Dog on a Great Dane Dog lead... If he does not find out exactly what it is, he does not know what to do.......

    Is this right?

    I would have thought to cut it out and then check with Pathology to make sure you got it all.......

    Should I put my trust in this guy and go for double appointments and cuttings?

  2. #2
    Senior User
    Join Date
    Jan 2014

    I am not entirely sure either. My experience has been similar to yours, though, outside my melanoma diagnosis which wasn't handled by a dermatologist, my experience with dermatologists is only with very small lesions (less than or equal to the size of a pencil eraser). In your case, it is possible the dermatologist is not sure if he is the one to do the surgery, or, if the lesion does turn out to be cancerous, he would need to refer you to an ENT specialist or oncologist. If he is suspicious of skin cancer, it may be that he is concerned that the ENT or oncologist would have preferred to biopsy or remove the lesion themselves. That is not to worry you, but just my best guess at what your dermatologist might be thinking. Others here with more experience might have a better answer.

    With my melanoma diagnosis, my OB-GYN did not do a biopsy but referred me to a GYN oncologist. He said he wasn't sure whether it was melanoma, but he thought the oncologist would prefer to do the biopsy himself in the event that it was.

    At any rate, it could still turn out to be benign, in which case your derm would probably remove the entire lesion. But that is assuming I'm on the right track with my thinking, and I'm not a medical professional so that is just my best guess.

    When in doubt, get a second opinion! Other than cost, it never hurts to get one when something a physician is doing or not doing is just not sitting right with us. As you said, if you are going to put your trust in someone, you should feel overall confident they know what they are doing.

    Vulvar mucosal melanoma, superficial spreading type, stage I-II, depth 1 mm with regression
    Radical right-sided hemivulvectomy, clitorectomy and bilateral sentinel lymph node biopsies, May 2013, lymph nodes clear
    PET CT, NED, July 2013
    Partial left hemivulvectomy/reconstructive surgery Oct 2013, found melanoma in situ on pathology, out to margins
    November/January - Underwent 9 vulvar biopsies to try to locate the MIS for surgical excision, unsuccessful
    May 2014 - Third vulvectomy/second left hemivulvectomy for wide local excision of MIS, MIS not identified on pathology
    PET CT, still NED, June 2015
    PET CT, NED, June 2016
    No sign of recurrence, January 2019

  3. #3
    Administrator Top User Kermica's Avatar
    Join Date
    Jul 2009
    Hi, Paul, and welcome though I am sorry you have reason to be here. For my two skin cancers (one BCC, one SCC), in both cases, my GP removed a portion of the lesion and sent it to pathology for analysis.It sounds to me that this is exactly what the dermatologist is proposing. When the path came back positive, I was referred to another dermatologist who specializes in Mohs microsurgery. In this procedure, which is done in office, the doctor excises the lesion and immediately prepares slides for examination. The objective is to get the entire lesion out with clear margins which greatly enhances the probability of keeping the cancer localized and minimizing the possibility of it returning.

    One reason he may not have wanted to take the entire growth on the spot may be that, cosmetically, things are more complex given that you are talking about removing a portion of your ear. Mine were behind my right ear and on my left temple so I didn't have that concern.

    One thing that we believe in here is the concept of the squeaky wheel. If you have questions and want thee answers you need to ask for what you want. You then need to become that squeaky wheel until you get the answers you need.

    Good luck to you and may the pathology come back negative for any skin cancer. That would be the best outcome of all.

    Good health,

    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 67
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09
    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.
    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.
    Significant progression detected in PET scan - December 2012
    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.
    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.
    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".
    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.
    June 2014 - started 2 year maintenance Rituxan, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.
    February 2015 - Doc and I agreed to stop R maintenance as it is depressing my immune system too much.
    June 2015 - Confirm that the beast is back by physical exam, will scan in August after esophageal issues settle down so we can get a clear view.
    August 2015 - physical exam in error, PET/CT shows no evidence of disease. Remission continues well into second year!
    December 2015 - Cardiologist tells me I have plaque buildup growing at an alarming rate. Stent or bypass down the road but not yet...
    March 2016 - new tumor below the jaw so remission is over. Back to active surveillance until treatment is needed.
    June 2016 - C/T scan indicates presence of multiple lesions in iliac chain.
    August 2016 - PET/CT shows multiple areas of lymphoma as expected plus new areas of concern in bowel.
    January 2017 - C/T scan shows significant progression in cervical and inguinal lymph chains, largest tumor is impacting hearing, measures 2.1x4.6 cm. 4 to 8 cycles of R-CVP, 1x3weeks to commence 2/6/17.
    April 2017 - Mid treatment scan shows about 1/3 reduction in multiple tumors. Also shows abdominal aortic aneurysm with peripheral thrombus. Cardiologist changed meds, spoke of need for surgical repair down the road.
    September 2017 - finished 10 rounds of R-CP, V was stopped due to neuropathy in feet. No further treatment planned at this time, at least 10 tumors can be felt which seem to be growing again.
    December 2017 - Biopsy of external iliac node with SUV of 13.1 shows no transformation! However, the FL grade is now 3A instead of Gr 1-2. Will start indefinite protocol using Copanlisib, one of the new targeted therapies. I remain hopeful.
    March 2018 - Copanlisib failed, treatment stopped 3/28. New plan is to go to Dana Farber on 4/16 for case review and treatment recommendation.

    May 2018 - did not qualify for clinical trials at Dana Farber. Tumors need to get larger to be considered. On consultation w/Dr. Armand at DF and my onc, have decided to take a break from cancer treatments. Will have a biopsy of the mass in my sinus discovered in scan at DF and to get the aneurysm repaired as it has developed a potentially catastrophic penetrating ulcer. Surgery scheduled for 7/12.

    September 2018 - biopsy of mass in nose shows transformed DLBCL throughout. Assessing options for this negative development.

    October 2018 - started 6 to 8 cycles of R-CHOP. Goal is to get to full remission to open up other options.

    February/March 2019 - PET shows four hot spots following R-CHOP. referred to Dana Farber for stem cell transplant. Pre testing all good, accepted for Auto Transplant. Will begin inpatient process about April 1.

  4. #4
    Regular User
    Join Date
    Mar 2014
    Hi Paul, i agree with the others, if you have any doubts what so ever, always get a second opinion.
    It does seem strange to take half of it to send away when they normally just do a small biopsy. If positive remove the suspect spot with with a safe margin. Ring him ask why he does it that way.
    My GP checks my skin every 6 months then , as he says he doesnt specialize in skin cancer only does my biopsy and then for my skin cancer treatments he sends me onto another GP in the practice who specializes in skin cancer, i have every trust in her now . I should she has had alot of me cut out.
    The first bcc lump i had on my earlobe was 5 years ago, looked like a small pimple that would never fully heal. But it was a aggressive nodular bcc, so they took all my ear lobe to get it all. I am going for core biopsy this friday on a ulcerated lump that too wont heal on the inner rim of the same ear. This is much larger and being on cartlidge its going to hurt. I am dreading the amount of ear that will get cut out concidering its size. But the good thing is it will get cut out and be gone. And i will just have a much smaller ear , but have grown my hair and now you cant even see my ear.
    Keep us postedon how you go, goodluck

  5. #5
    Regular User
    Join Date
    Mar 2014
    Well my core biopsy on my ear went well, didnt hurt as much as i was expecting. Though they did have trouble getting it to stop bleeding, even asked if i was on blood thinners. Told them i wasnt . But eventually it slowed enough for a dressing to get me home and change two more times before it clotted enough to stop bleeding. I get the results tomorrow. My gp said he cant remove it if it comes back cancer. He was almost certain no one else in the clinic is qualified to remove it either as it will be cosmetic. I said i bet dr Roz can do it, lol he said he will talk to them all for the best option.
    How did you get on Paul.

  6. #6
    Regular User
    Join Date
    Nov 2009
    Quote Originally Posted by Paul J View Post

    This specialist wants to take out half of it and send it for testing.....

    Is this normal?
    Yes, it's common to remove half for biopsy. One reason for that is, believe it or not, the risk of losing the specimen during the process. The other half still attached to you is a backup. This according to my aging dermatologist. Good luck.
    DX 8/14/09 Age 56, PSA 4.1, T1c, 4+4.
    RRP 10/12/09, 3+4, T2a. Margins neg. Prostate extension, seminal vesicle - absent. NOMX.
    11/23/09 PSA .01
    6/21/10 PSA .01
    July 2011 PSA .01

    DX Malignant Melanoma in Situ 3/5/12
    Surgery 3/15/12
    No invasion, clear margins


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