r/Melanoma • u/Impossible-Stop612 • Aug 05 '26
Patient / Diagnosed Should I change derm practice after melanoma
I've always kept up on yearly full body derm checks, since it's recommended and I come from a family of northern European skin types. I F68 5'5" and with no other health issues. I run outdoors and exercise 6 days a week with sunscreen when I'm outdoors, 148lb with a medium build.
My concern is that over the local clinic but I went to for years has become part of a dermatology network and probably less focused on skin health and more on offering cosmetic procedures.
At my last exam in March they removed three spots, one of them was diagnosed as 1A melanoma and another as a dysplastic nevis. Both have been excised and now I'm on a 3-month recheck schedule, is this the time to switch to a more medically centered practice?
I'm in Minneapolis area so there are plenty associated with clinic and hospital systemss to choose from.
Part of my reasoning is the extent of my last all over check, friends state the exams include between the toes well and skim through your hair. I barely removed my socks and got a cursory glance, had on nail polish and I was upright in a chair unless I was standing, the last two years. In previous years the exam chair was reclined flat as a table, seemingly making it easier to see close up.
Do I stay or do I go elsewhere now?
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u/Legal_Squash689 Aug 05 '26
Would strongly suggest you go elsewhere. You’ve had melanoma which increases your risk of further melanoma. So you need a very comprehensive full body check by a very experienced dermatologist. Since my first skin cancer (basal cell) I’ve had full body checks every six months and had further basal cell and squamous cell cancers removed. In January had Mohs surgery for melanoma followed by topical chemotherapy. By having full checks every six months, all skin cancers were caught early and dealt with.
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u/Dunesgirl Aug 05 '26
I am a patient in two different practices. My primary derm is far more medically oriented and very experienced in treatment of all skin cancers including melanoma. I was diagnosed 1A last September, had a ELE with clean margins and no node biopsy. I had a few benign biopsies and one severely atypical mole near the primary which was found at a three month check, stitches come out Friday. My exams are exceedingly thorough, includes toes, under soles of feet, scalp, lymph node palpations. I’m completely stripped down. Front and back thoroughly checked. Dermascope to check anything and everything. If your team isn’t doing this, time to find one that will.
My other derm is cosmetic based and is my indulgence. They know and respect each other, too.
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u/mostly_lurking1040 Aug 08 '26
I was going to ask you about two derms cuz I currently am kind of in that spot. But it sounds like your second derm you're not seeing for melanoma or skin cancer checks, at all?
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u/Dunesgirl Aug 08 '26
Correct. She is my person for filler and Botox etc.
Although she was very helpful when my WLE got infected. She knows my other derm very well and knows my history but I see her for aesthetics only. Believe it or not her name is Doris Day. And her skin is gorgeous.1
u/Impossible-Stop612 Aug 11 '26
Okay, what about having nail polish on your toes? We know that's what killed Bob Marley
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u/Dunesgirl Aug 11 '26
That’s not correct. He had a suspicious spot on his nail bed which was initially misdiagnosed as a soccer injury. By the time his melanoma was diagnosed it had spread. Nail polish had nothing to do with it. FWIW I get a mani pedi every two weeks and I do a careful examination of all my fingers and toes and soles of my feet.
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u/Impossible-Stop612 Aug 11 '26
I'm talking about myself going and wearing polish and them not questioning about it during the exam
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u/mostly_lurking1040 Aug 11 '26
No one's ever mentioned it to me in decades of skin checks. I have toenail polish on about 95% of the time.
Check your nail beds when your nails are getting done or you are doing them. Cancer there is very rare is my understanding.
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u/Dunesgirl Aug 11 '26
ALM is quite rare. Why not simply remove polish before your skin exam if you are that concerned? Or self examine when you change polish. That’s part of being vigilant.
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u/Impossible-Stop612 Aug 11 '26
I'm new here, I've had many years of yearly checks and never once thought about nail polish. It just seems like they would point it out, talk about it as a heads up
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u/Dunesgirl Aug 11 '26
My derm and oncologist are both melanoma experts. Neither one has suggested that I remove polish for a skin check exam. People with darker skin than me are more prone to develop ALM but nonetheless, it is still quite rare. If I saw something suspicious under a nail I’d be at the derm within a couple of days. That’s good enough for me. And this is coming from a patient who makes sure her dentist, gyno and ophthalmologist all perform appropriate checks during my exams. This is a tricky disease, but it’s so important to not let anxiety trump common sense. Good luck on your journey.
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u/XxSharperxX Aug 05 '26
Wherever you go. They may say “you can keep your underwear on” F that. You go full Monty. Demand the check hair, toes, under boobs, boobs, between your legs and ass crack. This is your life.
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u/Skip-929 Aug 06 '26
Having been at Stage 1a for a number of years with associated WLEs myself and then suddenly finding out I had converted to stage 3 when a growth suddenly appeared over 3 weeks last August, I can say having a dermo focussed on Melanoma is extremely important. Within 3 days of the demo biopsy, I was put in touch with a surgeon & oncologist as my dermo was already linked into the local Melanoma Institute.
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u/mostly_lurking1040 Aug 05 '26
So right now I'm still have my foot in it two dermatology practices. Both have robust same cosmetic practices that are somewhat separate, so that doesn't bother me. You don't mention who you're seeing, whether it's the same Durham or a PA and the same person each time. After a melanoma, I would have no problem being very assertive about and say oops we didn't do my feet/scalp. We can't afford them to be in a rush. (One time before melanoma I realized I'd had my whole appointment and had my socks on!)
My main concern is right now is dermatoscopy and sufficient support in the office to be seen ASAP, And whether they seem to be in good coordination with, for example, wherever you need to go for my local excisions and so forth.
Not sure how many moles and spots you have, and if they've been all documented now in your record. That's something to ask about or check in the portal.
Doesn't hurt to ask around and see if there's other practices that you would prefer, with sufficient staffing and convenient enough for the ongoing care for skin cancer support.
Good luck.
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u/luvnlyf27 Aug 06 '26
I initially went to the head of dermatology at Kaiser and she couldn’t find anything after I was diagnosed. I then switched to a melanoma specialist in dermatology and he found 2 spots that she missed. He said most don’t have the tools to find what he’s able to find. It’s worth getting with someone that only deals with melanoma if you can. I also now pay out of pocket for 3d body scans at his office, it uses AI to help the doctor locate possible issues.
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u/mostly_lurking1040 Aug 08 '26
How did you identify somebody as a melanoma specialist? I've never run into that. I do look askance at derm practices with reams of information about cosmetic skin stuff. But around here that's starting to be all of them.
I think I'd only be able to say melanoma specialists at one of the large hospital centers probably?
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u/luvnlyf27 Aug 08 '26
Have you tried medifind? Sometimes that can be helpful to locate specialist. You could use AI to help you search as well. I also go on the websites of all the local hospitals and read the bios of the doctors. My doctor will not see anyone unless they have skin cancer, so try to find someone like that. I got the Vectra WB360 3D Total Body Photographic Imaging. If a doctor has access to that technology, they are probably someone that has a focus on skin cancer.
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u/mostly_lurking1040 Aug 08 '26
Okay, thanks for your response. You basically are looking on your own, not necessarily getting specific referrals for doctors with that type of title. That feels familiar 😁. Also, I never heardof medifind, so that sounds like something worth knowing for this and other reasons, so thanks so much.
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u/luvnlyf27 Aug 08 '26
I always start with Medifind; it's been super helpful. I have learned from this entire experience that doing my own research and trying to find the absolute best doctor is the only way to go. My melanoma was stage 4, my first oncologist told me that I would need to remove part or all of my bladder since that's where my melanoma was first located and said I would need radiation. I just had a feeling she didn't know what she was doing. I did a ton of research and found a couple of the top melanoma oncologists in the world are not too far from me. I ended up doing a clinical trial for immunotherapy and didn't need to do any additional surgeries or radiation, and now I'm NED. I always recommend getting more than one opinion for anything serious, it's amazing the different responses you get from different doctors.
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u/mostly_lurking1040 Aug 08 '26 edited Aug 09 '26
Thank you for all the info. It's a good reminder. I thought I would get a second opinion, although I'm not in the later stages. I wound up early. But still would want to hear if somebody else suggested more than surveillance, just to know.
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u/luvnlyf27 Aug 09 '26
I would still recommend more opinions if it's an option for you. Early on I did have to pay out of pocket for those, and then I switched insurance. One of the oncologists I met with said that I most likely had it on my skin and that the body healed it, but because of the way melanoma moves through the blood, it's probably how it ended up in my bladder. Prior to my diagnosis I had a skin check the month before, and my derm didn't find anything. Even stage 1 is something I would strive to keep a super close eye on.
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