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  • #21929
    Ajones1123
    Participant

    Hi all,

    My mother is going in for a wider excision on Monday for an atypical mole she had removed. I know there is a TON of knowledge on this board and many of you are extremely educated when it comes to how to interpret pathology, etc. I just want to know if anything looks extremely alarming on her path report and if conservative excision is appropriate. The report is as follows:

    Diagnosis: Compound Nevus with moderate to focally severe atypia

    Microscopic description:

    Left Calf: Sections show a proliferation of somewhat spindled melanocytes that are arranged in nests and as single units with a confluent pattern of growth mostly within the lower portion of the epidermis. Nested melanocytes are irregularly distributed in the lower portion of the epidermis, and nests bridge between adjacent rete ridges in areas. The melanocytes display moderate cytologic atypia, including variation in nuclear enlargement and staining intensity, mostly at the dermoepidermal junction. The superficial dermis shows nests and strands of similar appearing melanocytes. Additional dermal changes include fibroplasia, variable mononuclear cell inflammation, and scattered melanophages. Scattered melanocytes also demonstrate variable degrees of cytoplasmic pigmentation. The immunostain for Melan-A shows a brisk junctional proliferation of atypical melanocytes with confluent growth pattern accompanied by a subtle limited pagetoid scatter above the dermoepidermal junction. It also highlights nevomelanocytes in the dermis. These findings represent a compound nevus with moderate to focally severe architectural and moderate cytological atypia.

    Comment: while the specimen margins are free in the planes of sections examined, the distance to the peripheral edge is only about a millimeter, and conservative re-excision is recommended to ensure complete lesion removal if clinically warranted.

    Thanks in advance to anyone who has any input on the report. Is this just basically an atypical nevus (closer to the moderate end of the spectrum)? Is conservative re-excision appropriate? Thanks again!

    #64163
    Catherine Poole
    Keymaster

    That’s all I see is a mole/nevus. But it is good she’s examining her skin and you are looking out for her!

    #64164
    Ajones1123
    Participant

    Thanks so much for your reply Catherine! I’m such a worrier. I’ve been trying to decipher every little thing in the report to make sure something wasn’t missed, or more sinister than it appears. The dermapathologist has over 30 years experience, so it’s not that i don’t trust them…it’s just the worrier in me lol. Wondered about the “subtle limited pagetoid scatter” and trying to figure out what “confluent growth pattern” means. My internet search seems to only show results for Melanoma and not much on atypical or dysplastic nevi. Is it also somewhat standard to use the Melan-A stain, or does that indicate that they thought it was a melanoma instead of a dysplastic nevus? Thanks again for any input!!

    #64165
    Worrywart
    Participant

    This is an atypical mole that was getting close to becoming malignant. Focal (in one small area) there is pagetoid spread (upward spread) which is a characteristic of melanoma in situ. The wide excision will take care of it, and your mom should now be alerted that she is higher risk and needs to protect her skin from the sun and do regular skin checks to watch for new or changing moles. Also a good idea to watch the excised area for pigment regrowth. I wouldn’t worry though, sometimes its good to get a warning!

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