Shave biopsy - melanoma in situ. Wide excision - nothing?

Posted By
7/12/2014 3:31pm
Replies: 1

Last month had a shave biopsy done of a very small mole (about 1 mm) on my arm during a routine visit to the dermatologist.  The Dr. originally did not spot it but asked me if I had any moles change color/shape recently.  I told him I thought the one on my arm did (but I wasn't sure).  He did a shave biopsy on it, and a couple of days later I got a call from a nurse saying it was severely atypical and I needed to come back in 2 weeks for a wide local excision to take the whole lesion out.  The path report concluded a differential diagnosis for an early melanoma in situ.

So I was worried sick for 2 weeks and had the wide local excision done, taking a good inch of skin out.  But the 2nd path report said they could not find any neoplasm, melanocytic or otherwise, on the skin.

I am feeling like I was taken for.  Not only do I have a very visible (and probably permanent scar), but they hit me for a bill for almost $500 after collecting over $1200 from my insurance company.  They never explained any of the costs to me, only charging me for regular office visits each time, which made me assume it was covered until they hit me with the bill (to be paid immediately).

I am considering whether I should get my tissue samples from them and get a second opinion.  Would this be advisable or would I just be throwing more money away?  Thanks for your advice.

What you had was "standard protocol".  Even if the biopsy removes the entire lesion (as was likely in your case), the WLE (wide local excision) is standard.  Melanoma cells like to "travel", so they go in and get extra margins "just in case" there are extra cells that were outside the biopsy.  It is very common NOT to find melanoma or atypical melanocytes in the wide excision material.   I'm sorry your doctor didn't explain what was happening or the extra cost of the surgical procedures,  You can get a second opinion if you think that's necessary.  Was the pathology done by a dermatopathologist (pathologist who specializes in skin)?  Personally, I probably wouldn't bother.  You have a diagnosis and the offending tissue removed.  You followed standard protocol.  But if you would feel better having someone else look at the samples, go for it.  It's all what makes YOU comfortable!