<p>Pathologist here: Watch those moles! Use your sunscreen! Wear a hat!</p>
<p>Melanoma is an unpredictable tumor. Many melanomas seem to have a complicated relationship with the immune system, or perhaps a complicated path of genetic mutation. For whatever reason, some low stage melanomas will recur after many years, some people with what appears to be high risk melanoma will never have distant mets, and some people will present with metastatic disease unfortunately and no identifiable primary. </p>
<p>Suspicious skin lesions should be excised with enough depth to allow the pathologist to visualize the deep margin of the specimen. It is acceptable for a benign mole to be shaved, and a thin melanoma can also be shaved, although we still prefer a deeper excision, because shaves are so thin, sometimes they don’t get oriented properly during processing and that is a disaster in a melanoma. We have to measure the thickness of the melanoma microscopically, and that requires a well oriented specimen.
Even the best dermatologist can get fooled by a mole, so we do the best we can.</p>
<p>Also we ask the clinician to NOT send the primary resection for frozen, that can mess us up too, very few do that nowadays. Sentinel nodes are sent for frozen, and rarely the wide local excision (which in our community is often the second excision).</p>
<p>African AMericans are not completely exempt from melanoma - they should watch their fingers and toes particularly, because there is a melanoma that develops under the nail that they can get.</p>
<p>When I first trained, we didn’t think of melanoma as a childhood disease, but in a rather small practice, I’ve seen a 12 year old who died at 15 and a 15 year old who died at 20, so watch your children, too, particularly if there is a family history.</p>