Biopsy on freckle came back with atypical cells. Help me believe the nurse that it isn't cancer.

[carnelians 7]

I feel furious that the doctor used such alarming language with me. He even pointed to a melanoma picture and said, "We worry about this, because this can kill you." Uh, yeah!! I know!! That's why I've been in such a state for ages over this!! I even went out of my way to say that I have severe anxiety in hopes that it would make him treat me with a little more delicacy, not load me with uncertainties and things that don't even make sense. 

I feel so hopeless. I feel like this will be the rest of my life, waiting to get cancer and having a bunch of scares, getting things cut out of me and sent off for testing. I don't even have insurance anymore. God. 

[Shanowl80 73]

It’s completely normal for them to do this. They will take more skin and test it to make sure there is no more suspicious cells. 

[carnelians 7]

, Is it just a caution thing? The way he made it sound was so alarming like I'm teetering on the edge of cancer, or that it WAS cancer. Everything I'd read before this visit was that atypia even severe atypia still wasn't cancer or even pre-cancer. God, I feel so shaken up.

[mollyfin 366]

The doctor literally told you, once this is done with, you're done with it for good.  News doesn't get much better than that.  Even if it was early melanoma, so what?  This is how they treat early melanoma - they excise it, you schedule your skin check in six months, and everyone moves on with their lives.  Your anxiety is the issue here.   Just because you "feel like" you were diagnosed with stage 4 cancer doesn't mean that you were.  I felt like I was given a death sentence when I was told there was a 10% chance I had a rare sarcoma.  Guess what?  I'm still here!   Just because something feels true doesn't mean it is true.   Someday you may get cancer; one in three people do.  But you don't have melanoma right now.  The doctor told you that.  The nurse told you that.  The problem is that you're listening to your anxiety instead of them.   

[carnelians 7]

Thank you. I feel like there's a huge brick wall between my brain and staying rational. In the very back of my mind I feel like if I'd never gone in to get it looked at, it still would have never turned into anything bad and I would have gone forever without even knowing it was atypical. 

Honestly you're right -- I need to try thinking of this as being lucky that even if it was my worst fear it's extremely manageable and it'll be done with on the 21st. I guess I'm just super jealous of people without health anxiety. When I hear about people who routinely have to go in for excisions and they're not worried at all, I straight up can't compute it. Even people who have had multiple actual melanomas are calmer than me. I just can't imagine not being terrified all the time at any change in my body. 

[MARC 431]

I had basal cell carcinoma on my right upper nose 10 years ago and it was removed by a Mohs surgeon and he told me there was a 99% chance it would not come back and I go to a dermatologist every 6 months for a full body screening. My friend had Melanoma from a freckle 7 years ago and he is fine. Someone who works for me had insitu Melanoma on her face 5 plus years ago and she is fine. 

[mollyfin 366]

I know how you feel about being jealous of people who don't have HA - must be great to deal with these things without assuming everything is a disaster!  

[AndrewF 37]

On 3/6/2019 at 7:17 PM, carnelians said:

I......really need support today. This is the worst I've ever felt, and I've had panic episodes that have landed me in the ER. 

I just got back from my followup. They described it as "moderate to severe atypia" and have scheduled me for a wide excision to be safe. The doctor didn't have the best bedside manner and said a bunch of terrifying things like how atypia can lead to cancer and how they "can't be certain it wasn't early stage melanoma" because of it being moderate to severe which made me break out into a cold sweat and burst into tears right in front of him. He made it sound WAY scarier than everything I've read. I thought atypia was common; it's the only thing that's kept my head on straight this whole time. He made it sound so much worse than anything I'd read.

They gave me my pathology report, but I don't really understand a lot of it. Basically it says "the findings are those of a junctional melanocytic nevus with moderate to severe atypia" and that a wider excision is suggested. "Neoplasm of uncertain behavior" is in there too. One part that freaks me out because I don't understand it is "As the neoplasm extends to both lateral tissue edges, complete excision is recommended." What the hell does that mean? Does that mean it's on its way to being cancer? Are the cells left behind cancerous and killing me right now? 

 

So, another useful anecdote.  My wife had one of these too.  Doc did an excision.  Gone.  Said it was not melanoma but "pre cancerous, kinda"  This was like 14 years ago or something.

Your doctor is looking out for you.  If it was an acute risk, you wouldn't be waiting until the 21st for the excision.  It sounds like the report is insinuating that the biopsy sample didn't havea  margin around it, so there are some atypical cells remaining on you, and taking those is in your best interest.  

Lots, meaning thousands, not millions, of people "get" malignant melanoma every year.  Its just removed surgically.  You dont even have Stage 0 of this disease yet, you have ....lets say...."stage -1"  The people who go on to cultivate this and then die of it are the ones who never go to the doctor and get checked out.  You should be feeling the same relief someone feels when they get their colonoscopy and the doc removes some advacned polyps that are pre-cancerous.  

All of our bodies are ticking time bombs, but the chances are you have a LOT of time left on the countdown clock, so do the surgery and keep moving with a good life!

 

[AndrewF 37]

On 3/6/2019 at 7:17 PM, carnelians said:

I......really need support today. This is the worst I've ever felt, and I've had panic episodes that have landed me in the ER. 

I just got back from my followup. They described it as "moderate to severe atypia" and have scheduled me for a wide excision to be safe. The doctor didn't have the best bedside manner and said a bunch of terrifying things like how atypia can lead to cancer and how they "can't be certain it wasn't early stage melanoma" because of it being moderate to severe which made me break out into a cold sweat and burst into tears right in front of him. He made it sound WAY scarier than everything I've read. I thought atypia was common; it's the only thing that's kept my head on straight this whole time. He made it sound so much worse than anything I'd read.

They gave me my pathology report, but I don't really understand a lot of it. Basically it says "the findings are those of a junctional melanocytic nevus with moderate to severe atypia" and that a wider excision is suggested. "Neoplasm of uncertain behavior" is in there too. One part that freaks me out because I don't understand it is "As the neoplasm extends to both lateral tissue edges, complete excision is recommended." What the hell does that mean? Does that mean it's on its way to being cancer? Are the cells left behind cancerous and killing me right now? 

 

So, another useful anecdote.  My wife had one of these too.  Doc did an excision.  Gone.  Said it was not melanoma but "pre cancerous, kinda"  This was like 14 years ago or something.

Your doctor is looking out for you.  If it was an acute risk, you wouldn't be waiting until the 21st for the excision.  It sounds like the report is insinuating that the biopsy sample didn't havea  margin around it, so there are some atypical cells remaining on you, and taking those is in your best interest.  

Lots, meaning thousands, not millions, of people "get" malignant melanoma every year.  Its just removed surgically.  You dont even have Stage 0 of this disease yet, you have ....lets say...."stage -1"  The people who go on to cultivate this and then die of it are the ones who never go to the doctor and get checked out.  You should be feeling the same relief someone feels when they get their colonoscopy and the doc removes some advacned polyps that are pre-cancerous.  

All of our bodies are ticking time bombs, but the chances are you have a LOT of time left on the countdown clock, so do the surgery and keep moving with a good life!

 

[Zazz 20]

Not per se related to a mole but I had atypical cells on my cervix. I had them biopsied (I had HPV and was completely freaking out), and they didn't even come back as pre-cancer or anything, just abnormal.

It's been probably seven years since I even tested positive for HPV. Everything's totally normal now and the cells never even came back.

If the doc says it's just abnormal cells, I can promise you it's going to be ok. They wouldn't lie to you about it. I know it can be hard but you're just going to have to try to trust them.

Take care.

[carnelians 7]

Thank you guys, these replies mean a lot.

So...I ended up having some sort of weird nervous breakdown and wound up in the ER the other night feeling like I couldn't breathe. Everything culminated in one huge attack and it was probably the worst I've ever had. They gave me a shot of Ativan. I've had two big attacks since and had to take an Ativan each time.

This is ridiculous. 

One good note is I'm finally prescribed a long-term medication. I went to a walk-in mental health facility today because I'd had enough of being in hysterics, so I'm giving Cymbalta a try. So at least this breakdown pushed me in the direction of finally letting myself try medication. 

I don't know why I can't get over this. I mean, I DO know, it's because I have a mental illness, but this is pretty over the top even for me. I miss my old obsessions, crazy as that sounds. This feels even worse than my psychosis obsession when I was 19 and that one really felt like the end of the world. I'm so sick of thinking about cancer.

[carnelians 7]

Day three on Cymbalta...it's too early to tell if it's actually helping or if it's a placebo effect, but I've had some good moments where I can think, "I have to accept the possibility that I will get skin cancer one day and keep living in the meantime." I've been reading up on radical acceptance with health anxiety and it makes some good points about relinquishing control and how worrying means you suffer twice. Now, when I have my bad moments I'm a mess (I had a bad morning, woke up nauseous from my meds and very anxious about the excision coming up) but I'm hoping the meds kick in soon for real and help with this obsessive thinking. Had to pop a klonopin in the meantime which my doc recommended as needed because he sees how messed up I am over this. 

My one worry is that when they do the excision and send it off, it'll come back as cancer because it'll have rapidly changed in four months since the biopsy. From what I've read this is super unlikely and that it takes way longer on the small off chance atypia does lead to melanoma, even for moderate to severe atypia, but that's what I keep going back to since it's coming up so soon. Besides that, I don't trust the derm not to say some other hamfisted thing that I'll obsess over, which I really can't afford right now while getting adjusted to medication. I'm worried about how it was diagnosed as moderate to severe so it's straddling some weird line, and apparently severe atypia can sometimes look like early melanoma? There's so much conflicting information. I need to stop googling and feel like I can't.

[utrocket09 115]

34 minutes ago, carnelians said:

Day three on Cymbalta...it's too early to tell if it's actually helping or if it's a placebo effect, but I've had some good moments where I can think, "I have to accept the possibility that I will get skin cancer one day and keep living in the meantime." I've been reading up on radical acceptance with health anxiety and it makes some good points about relinquishing control and how worrying means you suffer twice. Now, when I have my bad moments I'm a mess (I had a bad morning, woke up nauseous from my meds and very anxious about the excision coming up) but I'm hoping the meds kick in soon for real and help with this obsessive thinking. Had to pop a klonopin in the meantime which my doc recommended as needed because he sees how messed up I am over this. 

My one worry is that when they do the excision and send it off, it'll come back as cancer because it'll have rapidly changed in four months since the biopsy. From what I've read this is super unlikely and that it takes way longer on the small off chance atypia does lead to melanoma, even for moderate to severe atypia, but that's what I keep going back to since it's coming up so soon. Besides that, I don't trust the derm not to say some other hamfisted thing that I'll obsess over, which I really can't afford right now while getting adjusted to medication. I'm worried about how it was diagnosed as moderate to severe so it's straddling some weird line, and apparently severe atypia can sometimes look like early melanoma? There's so much conflicting information. I need to stop googling and feel like I can't.

Stop googling...there is your answer. The do the extra excisions to get everything. Once they remove thats it. My husband had 2 that were moderate to severe. Since then...nothing. it healed and we went on with life.

[ConstantWorrying 8]

On 3/6/2019 at 6:17 PM, carnelians said:

I......really need support today. This is the worst I've ever felt, and I've had panic episodes that have landed me in the ER. 

I just got back from my followup. They described it as "moderate to severe atypia" and have scheduled me for a wide excision to be safe. The doctor didn't have the best bedside manner and said a bunch of terrifying things like how atypia can lead to cancer and how they "can't be certain it wasn't early stage melanoma" because of it being moderate to severe which made me break out into a cold sweat and burst into tears right in front of him. He made it sound WAY scarier than everything I've read. I thought atypia was common; it's the only thing that's kept my head on straight this whole time. He made it sound so much worse than anything I'd read.

They gave me my pathology report, but I don't really understand a lot of it. Basically it says "the findings are those of a junctional melanocytic nevus with moderate to severe atypia" and that a wider excision is suggested. "Neoplasm of uncertain behavior" is in there too. One part that freaks me out because I don't understand it is "As the neoplasm extends to both lateral tissue edges, complete excision is recommended." What the hell does that mean? Does that mean it's on its way to being cancer? Are the cells left behind cancerous and killing me right now? 

I'm completely ratted. I came out of there feeling like I'd just been diagnosed with stage IV cancer. The nurse reiterated that it's not cancer, and the doc said that for my health anxiety's sake, once they do the excision it is completely gone and I'll never have to worry about it again. It went in one ear and out the other. I cried for an hour in the car on the phone with my mother. 

My appointment is on the 21st. No idea how to handle this. I just got a new job. My girlfriend just landed a great design job so we can finally get on with getting our own place. All of this feels worthless now because I'm too afraid I'll suddenly get cancer and die. I have so many freckles and moles that I feel like a ticking time bomb with a 100% certainty of getting melanoma one day. Maybe I already have it and haven't even seen it. I straight up can't deal with this uncertainty.

I showed him the other freckles I was worried about and he wasn't concerned with those at least, just took some pictures and said to keep an eye on them for changes. But now I'm back to worrying about this one spot that I thought I was completely over once it was cut out. Come to find out it wasn't a complete cut and that there's still parts left behind? I can't do this. I;'m thinking about having to call some sort of crisis number because I don't want to dump this all onto my girlfriend or my mother all over again. They can only do so much. 

Remember what I said about melanoma in situ. It's not life-threatening. 0 chance of killing you when removed with wide excision. 

"Atypia" just means (and this isn't just in layman's terms), "we aren't sure." The differential diagnosis is melanoma in situ (0% chance of killing you) vs. nevus. When they say "atypia," they're saying, "I don't know whether this is a nevus or a melanoma in situ." That's it.

The problem is doctors suck at explaining this stuff, and many of them still believe in the outdated "pre-cancer" (dysplastic/atypical) model. The myth of pre-cancer has evolved over many years, from doctors originally thinking that only elevated lesions could even be melanoma, to thinking only HUGE flat melanomas were the start of melanoma, to now believing that new lesions that look like nevi start out benign and then transform into cancer. But the recent research demonstrates that a lesion is either benign or malignant from the very moment it first appears on the skin, and doctors and pathologists just don't know until it evolves enough to show its characteristics.

Get the wide excision and then just make sure to get more frequent checkups (because as I said before, those who have had one melanoma in situ have a higher chance of some day getting another...because if the conditions in your body were there for it to happen once, there's a higher chance of it happening again). I would also recommend doing a monthly self check on your skin and keeping picture records.

But once again, to reiterate: Melanoma in situ poses no risk once it is widely excised. Superficial spreading melanoma (flat) takes a long time to go from in situ to stage 1. 

The concern would be if they had actually diagnosed it as melanoma in situ. If they're confident in a melanoma in situ diagnosis, there's a small chance of it actually being stage 1, where the survival rate, while still extremely high, isn't quite 100%.

But if they're on the fence about whether to even call it melanoma in situ, it sure as hell isn't stage 1.

I think the main thing is you have to adjust your way of viewing the word, "cancer." Not all "cancer" is created equal. Not even close. Basal cell carcinoma is a cancer, and that kills exactly nobody, ever (well, there have been like 100 cases in history where it killed people, but that was out of millions and millions of cases...BCC is so common it's a joke).

Melanoma - the superficial spreading kind - is something that only becomes deadly when you leave it to evolve for a long time.

That's the reason many dermatologists will now leave lesions they are unsure about on the skin for anywhere from 3 months to a year, and follow up. Because they know that at a certain point in a flat lesion's appearance on the skin, if it is melanoma, they have plenty of time to catch it and remove it before it poses any threat to the life of the patient. 

[carnelians 7]

Thank you. I think I needed to hear that again. The likelihood of it suddenly becoming some super dangerous stage of cancer is like 0% and if it did evolve since November it'd still be stage 0 at least. The thought of it still freaks me out because well, the word "cancer" is terrifying, but I think you're right that I assume all cancer is equal when it very much isn't. When I hear cancer I think of chemo and being bedbound and a long drawn out death even though I know that's not the case with everyone, or even the majority of people with cancer. It's that thing again where I can't picture a future for myself without a horrible illness wiping me out, or thinking I'm more prone than everyone else to winding up with something. No evidence of that, it's the depression and HA talking. 

They diagnosed it explicitly as moderate to severe atypical melanocytic nevus. The pathology report didn't mention melanoma at all so...gonna try and see the good in that. Can't wait for this whole thing to be over.