Sometimes it's good to be wrong.
July 17, 2006 9:24 AM   Subscribe

Symptoms of skin cancer, in more detail. How fast does it develop? How worried should I be? Just from checking health websites I'm starting to panic and the only dermatologists I can get ahold of don't have any appointments open until late August. I have no primary care physician so checking it with them is out. My symptoms are inside.

In the past week-and-a-half, two weeks a mole on the side of my face has changed dramatically in size, shape, and color. At first I thought it was a zit, but this looks like no zit I've ever had. It's gotten larger and darker, turning from red-brown and smooth-edged to brown-black colored with rough, irregular edges. This past weekend it started to bleed. The symptoms appear disturbingly textbook.

My only hope lies on the rapid changes in the mole (can it really develop that quickly?) and the fact all my serious sunburns (and unfortunately there have been more than a few) have been on my back.
posted by anonymous to Health & Fitness (32 answers total)
I'm not a doctor, but I am a patient and this sounds like a case that, at the very least, where you need to make a quick appointment with a primary care physician to discuss the situation with them. S/he will expedite a dermatological appointment if necessary. I recommend this, if at the very least, for your own peace of mind.
posted by mrmojoflying at 9:34 AM on July 17, 2006 [1 favorite]

you have an emergency. you need to see the dermatologist quickly. call them and tell them why, and they should fit you in quickly.
posted by lester at 9:36 AM on July 17, 2006

This is pretty serious, no doubt, but only on the order of 1 in 1000 moles ever become cancerous. You're right to have it checked out immediately, but I wouldn't worry until you have more reason to - likely that you won't.

I am surprised you can't get an appointment, though, since this is kind of a priority thing. I'd guess that the person on the other end of the phone is putting you in the queue with the Botox and abrasion patients, as is normally the case for most dermatologists that aren't skin cancer specialists. It can be difficult to impress upon them that you may deserve expedition, so I'd follow the advice above and get a PCP involved. You still want to see a derm, though, since their expertise really does come into play here.

Sunburn isn't as strongly linked to the serious type of skin cancer (melanoma), and even the weak link doesn't predispose it to develop in the place you received the burn. The most common areas for men are the trunk followed by the head and neck. If it's "just" a BCC/SCC, you're likely not in any serious trouble.. but I only say that because I know you plan to have it taken care of ASAP. Given a history of sunburn, the latter is probably most likely in my non-professional opinion.
posted by kcm at 9:37 AM on July 17, 2006

(Also, the majority of serious skin cancer cases from moles develop de novo - in new moles. I'm doing a really bad job of trying to help you not worry.)
posted by kcm at 9:39 AM on July 17, 2006

I had something that sounded very much like that on my cheek once, and went in for emergency treatment. The doctors were glad I did. They removed it immediaely, and luckily for me it was not cancerous. Please go in right now.
posted by tristeza at 9:42 AM on July 17, 2006

I agree that you need to be seen right away.

If you can't get an appointment with a dermatologist quickly, call your insurance company and ask them to hook you up with a nurse practitioner who has new-patient appointments available right away. Once he or she has examined you, the NP will be able, as mentioned above, to expedite your contact with a dermatologist.

Alternatively, if you live near a hospital, call their main number and find out if they have an urgent care clinic. If you arrive as soon as it opens, you should be seen relatively quickly by someone who can make a quick referral to dermatology.
posted by jesourie at 9:46 AM on July 17, 2006

FIFTH: GO IN IMMEDIATELY. The ER really is not out of the question for something changing that rapidly, if you can't get seen anywhere else, and they'd have onco's on call.
posted by baylink at 9:47 AM on July 17, 2006

Dermatologists are notorious for their lengthy appointment times, but if you call and explain the situation in detail, they can and will fit you in.

I have a friend who is in med school and claims that dermatology is one of the toughest fields to get into due to their extreme selectiveness. According to him, if they can control the number of doctors in their field, then they can also control the demand and thus continue being one of the most expensive types of specialty physicians. I'm not sure if this is true or not, but I've yet to meet a Dermatologist with a decent appointment time.

Side story aside, go see one as soon as possible.
posted by bjork24 at 10:07 AM on July 17, 2006

Find another doctor you can see immediately. If you cannot see a dermatoligst, see a plastic surgeon. They wil do the removal just because you want it off, but still send the removed tissue in for analysis to see if it was cancerous, and if so what kind of cancer it was and if they got it all out. In my case, a dermatologist diagnosed me, but I had the removal done by a plastic surgeon who did a great job.
posted by procrastination at 10:21 AM on July 17, 2006

Yes, doctor. Go see a doctor!

My mom had a bout with skin cancer, exacerbated by not taking action. Go to a hospital, and make them look at you.
posted by Drunken_munky at 10:21 AM on July 17, 2006

See if you can find a primary care provider. For someone like an internist or a family medicine doctor, the wait should be minimal. Although not dermatologists, they will be able to biopsy the mole and get it checked for cancer.
posted by corranhorn at 10:29 AM on July 17, 2006

You should have any biopsies done by a specialist, since it's common for general practice to be a shave biopsy which can mask the true depth of a lesion. If it's being removed for concerns of cancer, it should be a full-depth biopsy (punch/excisional) so the depth will be correct if needed.
posted by kcm at 10:52 AM on July 17, 2006

Echoing upthread, you shouldn't wait until late August to get this checked out. Did you describe the symptoms to the derm offices you called? If they won't help, the ER is better than waiting until August.
posted by desuetude at 10:58 AM on July 17, 2006

Response by poster: I have described the symptoms to the dermatology offices, as well as my concern. They have been met with non-committal sympathetic noises and the assurance that no appointment can be made until late August.
posted by Anonymous at 11:06 AM on July 17, 2006

You have no primary care physician, thus no one in your corner to wrangle with dermatologists. You need someone to do this.

1) Try a local walk-in clinic. They should have one or more dermatologists on their referral lists.

2) If there are no clinics in your town, then go to emerg at a low traffic time (if at all possible) and pitch like hell to the person who sees you. Tell them you have no physician, no walk in clinic access, and no dermatologist who will see you before the end of the summer. They might get pissy if you go there first, so let them know you've tried out every other reasonable option first.
posted by rosemere at 11:22 AM on July 17, 2006

You're just down the road from Johns Hopkins Hospital. Go visit them. The bleeding thing should be taken seriously by the staff.

There is construction right by the hospital so, look for the parking structures. When I recently visited, I parked in the McElderry Garage and walked right in. Just inside, there is an information desk. Stop there and ask them to advise you on where to go. It is a big place and easy to get turned around. However, I found the staff to be kind, polite and helpful.
posted by onhazier at 11:45 AM on July 17, 2006

The McElderry Garage is right next to the Outpatient center. The map does not convey the scale properly. I needed to get to the Wilmer Eye Institute and found it easily accessible from the underground walk. I am sure someone at that desk could direct you if nothing else.
posted by onhazier at 11:48 AM on July 17, 2006

I hope you're not reading this umpteenth suggestion to go to the doctor because you're already at the doctor's.
posted by hazelshade at 12:09 PM on July 17, 2006

Here's the contact info for the Melanoma and Cutaneous Oncology Group at Johns Hopkins. Even if you can't get an immediate appointment with them (though it certainly doesn't hurt to ask), they may be able to give you some specific resources for where to go next.
posted by scody at 12:34 PM on July 17, 2006

Agreed with everyone else on going to see a doctor ASAP. If you can't get a PCP appointment in short order (and I know that as a new patient it can be difficult to get a quick appointment with any doctor who hasn't seen you before), go to either an urgent care clinic or even a doc-in-the-box storefront.
posted by tastybrains at 12:36 PM on July 17, 2006

schroedinger-You might try the urgent care walk-in clinic out at Greenspring Station. It's open 24-7, isn't quite as hectic as an ER, and seems to handle minor emergencies like this pretty well. I would think that the goal of such a visit would be to get them to say that you need to go to the derm immediately, and then use that as ammo with the derm.

Let me know if I can help.
posted by OmieWise at 12:42 PM on July 17, 2006

Go to the dermatologist's office in person. If they still run you around, point to your face and say, "I'll wait two months for an appointment - if the doctor says it's OK to do so."

I wouldn't be surprised if they fit you in that day. Textbook descriptions of cancer are put into the textbook for a reason, and the reason is so that folks can recognize them in time, before untreatable cancer invades your whole body.
posted by ikkyu2 at 1:01 PM on July 17, 2006

IANAD, but I'm doing research in a tiny aspect of pigmentation and had to read through textbooks about melanoma. GO SEE A DOCTOR!!
You don't need to have had a sunburn to develop it either, so having been sunburnt only on your back doesn't matter.
posted by easternblot at 1:23 PM on July 17, 2006

I would second the suggestions for Hopkins ED or an Urgent Care. Christ, a doctor's a doctor - at some level, any one with a basic residency under their belt should be able to distinguish a melanoma from a pyogenic granuloma from a seborrheic keratosis. If you go, instead of saying "What the hell is this?" while pointing at your face, tell them it's bleeding, painful, and incredibly scary and you have no idea how to get into a doctor. If they treat you like a nuisance then they are beyond assholes.

Regarding the shave v. excisional biopsy issue, that's pretty well over, as far as I can tell. The melanoma gurus at OHSU don't get too hinky over depth issues since the recent staging criteria have more to do with sentinel node involvement than depth of invasion.
posted by docpops at 2:07 PM on July 17, 2006

Go now, insist, be a pest, use any connections you have, go to an ER, go to walk in clinic, actually I think the best suggestion is going to the dermatologists office and parking yourself there until a physician tells you to return in two months--you might also try a plastic or reconstructive surgeon, explain the symtoms or take a picture and drop it off--a reconstructive surgeon will be very sensitive to your plight--take a picture . describe its history and take it to a number of offices--you are describing the development of a very typical melanoma--asymmetrical, irregular order, change in color (multipigmentation)
posted by rmhsinc at 2:21 PM on July 17, 2006

I had the same symptoms 3 years ago (when I was 26), family doctor didn't think it was anything, but I pushed for a referral, got in quick to the dermo, who didn't think it was anything but did a shave biopsy... came back positive as early malignancy.

I had it removed and the second biopsy put me in the clear, but moral of the story is GO TO THE ER OR DERMO NOW, and insist!
posted by sonicgeeza at 4:27 PM on July 17, 2006

Make sure you mention it's on your face... they should be even more willing to fit you in since it's on your face...

Also, there are always cancellations... ask the dermatologist's office to put you on the cancellation list, and hopefully if someone else cancels their appt. you can get in even sooner.
posted by IndigoRain at 5:26 PM on July 17, 2006

Response by poster: Follow-Up: I called dermatologists back and pleaded with them--one will see me next Tuesday. The mole hasn't changed further and has stopped bleeding so hopefully that will be soon enough.

I haven't considered the emergency room yet because I'm afraid my insurance may not cover it. If the mole changes further in the next week I won't wait.
posted by Anonymous at 3:53 PM on July 19, 2006

You should be fine if they can get you in that soon. FWIW, since you are definitely seeking follow-up, it's inconceivable that a benign mole would undergo malignant change in a week and a half as you stated, so go in and get this cleared up once and for all, but try not to get spooked in the intervening days.
posted by docpops at 7:21 PM on July 19, 2006

Response by poster: Update: The mole is nothing. All is good on my face. Thank you all for your concern!
posted by Anonymous at 11:06 AM on July 27, 2006


By the way, in the meantime I noticed this article come across PubMed today:

Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists.
posted by kcm at 4:53 PM on July 28, 2006

glad to hear the good news, schroedinger!
posted by scody at 5:27 PM on July 28, 2006

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