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Help Deciphering Biopsy Please

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Help Deciphering Biopsy Please

Posted By
JennR
6/21/2012 10:58am
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Replies: 3

I had a suspicious mole removed at the derm's office a couple of weeks ago and got the results today.  The doctor called me personally and said that it was concerning, but he didn't feel it was cancerous and because of my family history of melanoma, he wanted to see me every four months.  I asked for a copy of my report and now I'm reading conflicting things online.  It sounds like some doctors recommend going in and getting better margins.  Here is what my report says:

PATHOLOGIC DIAGNOSIS:

Lentiginous Melanocytic Nevus, Compound Type, Irritated (Compound Melanocytic Nevus with Architectural Disorder)

 

MICROSCOPIC DESCRIPTION:

This is a compound nevus.  There is pigmented parakeratosis present.  There is architectural "disorder" characterized by a lentiginous proliferation of melanocytes between irrecgular nests of cells along the dermal-epidermal junction, highlighted by MART-1/MelanA immunohistochemical staining.  There is underying fibroplasia of the papillary dermis.  The intradermal component is bland appearance and matures with depth.  Original and deeper sections were reviewed.  (Compound Clark's Nevus or Compound Dysplastic Nevus)

 

Can anyone help me decipher what this really means?  Do I need to get a second opinion or just follow his recommendation of being seen every four months?

Thanks in advance for your help!

Jennifer

Janner - (6/21/2012 - 11:59am)

This is an atypical nevus or Clark's nevus.  It has architectural disorder but no cellular disorder is mentioned.  It doesn't grade the nevus (often times you might see "mild", "moderate" or "severe", but given the description, I do not read "severe" into it.  There are certainly conflicting opinions over margins when it comes to atypical nevi, but the only real guideline (and not everyone follows that even) is severely atypical nevi requiring 5mm margins.  If you had clear margins, that's probably adequate.  4 month followup visits seem fairly frequent if you've only had one atypical nevus even with a family history of melanoma.  But if that makes you feel comfortable, go for it.   If this doctor deals with melanoma a lot, then his judgement is probably good regarding this atypical nevi.  I probably wouldn't get a second opinion on the pathology.  I would, however, make sure that I had clear margins on this removal.  I would also watch the scar area for any signs of pigment regrowth in the future.  In general, this doesn't sound like a particularly threatening mole pathology wise.  Always good to stay on your toes regarding melanoma and get changing and suspicious moles biopsied.

Best wishes,

Janner

Anonymous - (6/21/2012 - 2:05pm)

See, I have these Clark's nevi/atypical nevi removed all the time. . sometimes they are completely excised with the biopsy, sometimes not.  But they never recommend me coming back for any further excision because they all seem to be mildly atypical. . but maybe not getting complete margins makes me nervous now.  Can that come back later as melanoma?

Just watch for any pigment regrowth in your scars.  If the lesion grows back, I'd probably have it removed to be on the safe side.  It probably won't be melanoma even then, but it is much harder to read the pathology through scar tissue - scar tissue makes cells look more atypical than they probably are.  If everything appears clear on your existing scars, I wouldn't stress these removals at all.  For mildly atypical lesions, many docs don't require clear margins because these lesions really aren't a threat to become melanoma.  Other docs want at least clear margins.  It's when the lesion is severely atypical that I'd definitely choose to get my 5mm margins.  The others, it's mostly a judgement call or comfort level - do what makes YOU comfortable!