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Have itchy mole on back. Suspected for basal cell or melanoma. How to treat this?

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Practicing since : 2006
Answered : 2015 Questions
I went to a dermatologist on Monday about a mole on my back that I've had since I was 8 years old. It was larger than a pencil eraser and always has been, but a couple of months ago, I scratched it while drying off after a shower. Since then, it has been itching and just looks weird, like scabby. Thus, I went to the derm on Monday. He immediately said that it was 50/50 basal cell or melanoma but wouldn't answer any further questions until the biopsy results on Friday. He removed the entire thing and when I asked if it went XXXXXXX into my skin, he said no and that that was a good thing. He never said anything about it maybe being an atypical mole that was irritated and rather jumped straight to cancer. I have a four year old child and am really freaking out about the possibility of melanoma and a prognosis of limiting my life. Please let me know what you think.....
Posted Wed, 13 Mar 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 49 minutes later
Thanks for writing to us.
The signs of melanoma are
A asymmetry that is two halves of mole do not match
B border irregular
C color variegated that is one half is red other brown black etc
D diameter larger than 6 mm
E elevated and evolution like itching inflammation, scabbing, pain,oozing etc.

Sometimes due to scratching inflammation might set in and lead to itching and scabbing. But since you had scratched the lesion two months ago and you still had itching scabbing till recently and along with that your nevi was big in size, your doctor did the right thing by removing the entire lesion and sending it for biopsy.

Some cases of hence your dermatologist must have kept it as a differential diagnosis.

Now having said all this, I want you to know
As your doctor said the lesions were superficial and he has already removed them completely, no treatment at all might be required
Basal cell carcinoma has a good prognosis as it is locally invasive and does not spread. So surgical removal is good enough as a treatment.
Even if it is melanoma, it has already been excised, so do not worry about prognosis
Lastly your doctor is a good doctor and has been cautious with his approach. He did not comment much as only biopsy can tell whether the lesion is benign or malignant.
Even if the lesion was a benign inflammed one, it was good to remove it as it had risk factors for developing into a melanoma and moreover follow up of your lesion on day to day basis was difficult as it was on your back.

Just be calm and do not worry, your doctor has provided you with the best management possible and most probably you would not require any further treatment if the lesion was removed with wide local excision.
Take care.
Above answer was peer-reviewed by
Follow-up: Have itchy mole on back. Suspected for basal cell or melanoma. How to treat this? 50 minutes later
So, it wouldn't make sense for him to respond with the fact that it could be an irritated atypical mole.... as far as i know it hasn't grown or changed in size.... it's always been dark brown and large, but since the irritation/scratch, it has changed in color, but only to look like it was scabbed or scratched. I'm sorry for the questions, I'm just worried about melanoma. And if it is melanoma, what is early detection? How many months/years does that mean..... and could my doctor tell upon removal that he got all of it out of my dermis/skin? Or is that something that only a pathology report could state.....
Answered by Dr. Kalpana Pathak 6 hours later
Thanks for writing back.
There is a possibility that it could just be an irritated inflammed mole but as you had few risk factors for melanoma like large size of mole, change in color, itching and scabbing, an urgent investigation to look specifically for any early malignant change was warranted.
Being a doctor even if a remote possibility of a lesion being atypical, dysplastic or malignant is there we would like to clear doubts to safeguard our patient's interest.

Melanoma is said to have progressed when the lesions become elevated, firm or enlarged in size and neither of these changes are seen in your mole. So obviously your mole has not progressed. Moreover your mole is on covered area with lesser chances of persistent sun exposure and you have no family history of melanoma. So all these factors probably provide you with excellent prognosis ie no Change in life expectancy. So do not think about extreme. Your doctor has already mentioned that the mole was superficial that means he has already removed it as whole.
Biopsy is done to confirm the nature of lesion and to ascertain its spread.

At this stage I can just say that there are chances of lesion being simply inflammed or have undergone an early atypical change. In either cases, excision was the best possible treatment option.

Do not panic, be hopeful.
Take care.

Above answer was peer-reviewed by
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