This is a long response, but for the person who wants to understand from someone who does, here you go:
I am a 5 year derm professional who is also a melanoma patient.
First, is is important to understand that melanoma is a cancer that forms in your pigment, or the cells that give color, hence they grow in moles because of the colored component.
Most likely, she has what is call Dysplastic Nevi. These are moles that resemble Melanoma, are biopsied, and are a specific type of mole that has a chance of turning into melanoma. Nobody is born with these moles. To simply explain cancer, is irregular cells, which have transformed from there original state, which spread in different ways. Dysplastic nevi(dysplastic = irregular; nevus=mole) are moles that are contain irregular cells but do not resemble cancer in any way, nor are spreading. These are very difficult for me as a medical professional to explain to patients as many patients are misinformed and scared to death. Sometimes referred to as "precancerous" they truly are not, as only a very small percentage of these will ever turn into melanoma. Dermatologists treat these differently as there are mild, moderate, and severe forms, each more irregular under the microscope. Many derms will not treat mildly dysplastic moles at all, while excising only moderate or severe types.
This is frustrating to me as many patients are scared to death of these moles or having a history of these moles, sometimes being told by their previous dermatologist that they are precancerous!
The truth is, after seeing thousands of these moles, and having many myself, will now give my own opinion. . .
I feel that these moles are overtreated. I will explain my experience so that you can underatand my professional opinion
As a human being,
when a patient walks into my exam room frantic about their previous precancerious moles, I think, "Oh, come on! If you truly knew how many people have these their whole life, and never treat them, you'd laugh!"
As a healthcare professional,
I think, "Yet another poor patient who has been sacred into believing this mole is rare, would have been cancerous, and is basically, in their mind equal to Melanoma.
As a patient,
Well this is funny, as I wasn't looking into dermatology and somehow fell into it. Knowing nothing about moles or Melanoma, and learning the physical characteristics of melanoma in my first 6 months as a professional, I realized that a mole on my back looked exactly like a Melanoma on one of our Melanoma Patient information handouts and worse than any mole I had ever seen in person. I showed the Derm I worked for and was scared to death when he said "Julie. This doesn't look good."
Now just so you can see the rarity of true melanoma suspicion, part of my job is to fill out the forms that ask the pathologist what to look for per the doctors request;
Almost every mole that is biopsied is sent in to ask if the mole is regular or dysplastic/irregular (written as nevus versus dysplastic nevus [ mole versus irregular mole] although rarely the diagnosis does come back as melanoma) and remember that derms biopsy (in my experience) between 6-20 moles a day.
This was the first time I ever filled out the pathology request as "severely dysplastic versus malignant melanoma." I was terrified.
My diagnosis was "severely dyspastic evolving into melanoma"
I had a very irregular mole that inside some of it's cells, but not all, were beginning to change into cancer. He removed it, and everything was fine.
That was 5 years ago.
After seeing thousands of patients with these moles, I feel that most are treated prematurely.
Look, dermatologists, just like any doctor have to watch their butt. They biopsy anything even slightly irregular. Although they know it will not come back cancerous. If they didn't, then what would happen if the one they did not biopsy was cancerous; huge malpractice lawsuit!
Do you know that most Melanomas do not come from moles at all? Most are a new brown spot that was not there before. The reason moles are watched is because they are are colored (pigmented) cells and therefore, just like your lungs can get lung cancer and your prostate can get prostate cancer, by being melanotic (containing color) your moles can get Melanoma.
Although any dermatologist will remove/biopsy anything irregular, you always have the right to consent to any treatment. Here are the schools of thought; depending on your belief, this should determine your treatment:
- Remove anything irregular
Pros: Optimal prevention . I have met patients who believe that if it isn't normal, take it off. Definitely a good way to prevent melanoma.
Cons: For many, unneccesary scars
- Remove what does not feel right
Pros: Treatment of hidden Melanomas (rare) otherwise not seen. In some cases, a patient will come in and sya mole doesn't feel the same as it used to or doesn't look the same. Even though the derm may believe it to look benign, if you ask for a biopsy, he/she will.
Cons: Missed skin cancers
-Watch for changes in your moles
Pros: unnecessary scars - A mole must change from it's original state to a different one for it to be cancerous. Avoid unnecessary scars as many moles can be irregular until the day you cease to live with no formation of cancer.
Cons: If you miss a change, you can miss a cancer.
My feeling:
Be aware of your own moles. Take photos if necessary.
I have a mole on my arm that has always been slighly irreglar; oddly shaped with a darker spot in the middle. Some of the derms said biopsy it, as they believed it to be dysplastic, and some said leave it alone. All agreed it was not cancerous.
I watched this mole for 4 years, not wanting a scar if not needed and knowing if biopsied at that point it would be dysplastic but not cancerous.
1 month ago, it grew a new dark spot. 3 days after I realized this, I told my boss and she took one look at it and told me it probably would just be dysplastic, if anything. However, because I paid close attention to it, I felt differently. It came back as a Melanoma in Situ. An early melanoma that is confined to my skin. I now will have it excised.
You can say I was irresponsible for letting it get so far. Or that It was responsible for me to pay attention.
I, personally, have many irregular moles. I can see them. I am young and do not want anymore scars. It is my decision to watch for any changing moles, then remove them. Although a total body exam is recomended for melanoma patients every 3 months, and I would never skip this. But I speak with my derm about my approach and she appreciates and respects it. There is no arguing with me as I have seen many patients who have neglected to pay correct attention, seek a physicians advice, and have also seen many patients covered in unnecessary scars.
In response to your case
FIRST OF ALL, HOW OLD IS YOUR DAUGHTER?
although melanoma can strike at any age, it is more likely, if she is a young child that the diagnosis will be a spitz nevus (benign)
WHAT COLOR HAIR AND EYES DOES SHE HAVE?
light hair and eyes is a risk factor for melanoma, especially red hair.
An oncologist is unnecessary (nor will they usually participate) unless a diagnosis of cancer is present.
MOST OF ALL, GET A FORMAL DIAGNOSIS!
Dysplastic nevus: Irregular mole; I have previously explained in depth as this is the most common.
Spitz Nevus: Benign mole that under the microscope resembles a melanoma and because of this is surgically removed.
Melanoma in situ:
Cancer of melanocytic cells but confined to the skin
Make your own decision. Find out what is wrong. Everyone is different. Be as aggressive as you wish.
Please email me with any Q&A.
I hope this helps.
Julie