Are the mildly dysplastic and atypical moles on pathological examination concerning?

Question

Hi doctor,

My 21-year-old daughter has had three dysplastic moles. They are mildly dysplastic. In the interim between having her yearly body check and going in for stitch removal, she was picking at what she thought was a small pimple or ingrown hair on her hip. She could not really see it, so after picking on it, she sent me a picture. I told her to have a dermatologist look at it. The dermatologist said it did not look like much in the picture. She was confused that it was actually the same area. So she biopsied it, and the pathology report was brief and basically said it was atypical, and that is all. We were told it could be nothing or could be anywhere in the range of melanoma. They sent it in for a FISH test which will not be back for four weeks. She has her graduation school interviews this month, she is freaking out, and I am trying not to. I have attached the picture she sent me mid-picking, but not when she went to the dermatologist when the dermatologist said it looked like nothing. What is your opinion?

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your case in detail and saw the picture (attachments are hidden to protect the patient's identity). It is good that you have already got the FISH (fluorescence in situ hybridization) test done, as one should be very careful in case of dysplastic moles. You need to make it clear that picking as such does not alter the pathology. It means it cannot convert into a malignancy. Sometimes biopsies are not descriptive as well, but the FISH test will be more reliable. In my opinion, any lesion or mole which undergoes the following changes should be taken as a dangerous lesion:

Asymmetry.
Change in color.
Change in size.
Ulceration or itching.

Unfortunately, this lesion looks slightly asymmetrical to me, which could be taken as a dangerous lesion. But this is my clinical opinion, and diagnosis can only be confirmed on a biopsy or FISH test. Just be patient. Try to relax her. I am not trying to scare you, but my duty is to tell you the fact. Just wait for the report and hope for the best.

Kind regards.