Q. Why is my mole proliferating even after excision?
Hi doctor,
I have a question about a mole. I had a mole biopsied a few weeks back, and the pathology report came back, as the pathologic process is that of the proliferation of nevomelanocytes within the epidermis and focally within the dermis. Cytologic atypia is present and manifests as large nuclei, pleomorphism, and abnormal chromatin patterns. No atypical mitotic figures are identified. An architectural disorder is present and manifests as lentiginous hyperplasia, horizontal growth pattern, individual melanocytic hyperplasia, and abnormally formed junctional nests that focally demonstrate bridging adjacent rete ridges. There is junctional asymmetry. The melanocytic cells extend to the deep margin and to both lateral margins.
The pathologist called it a "mild to moderate" atypical mole and suggested that I get it excised, which I did. However, when they went to check the margins, it was upgraded from "mild to moderate" to "severe." How concerned should I be about this? And why would a mole be upgraded upon excision? They are recommending another excision, as some of the cells were left behind, which I will do within the next few weeks.
Hi,
Welcome to icliniq.com.
Melanocytic nevi have an aberrant course and continue to show junctional activity. These areas can have cytological atypia, and a disorderly growth pattern of malignant melanoma develops in situ. Downward spread in the dermis results in invasive melanoma.
Also, junctional melanocytic nevi have greater malignant potential, although the exact incidence is not known. The maturation of nevi is accompanied by an alteration in antigen expression.
Incomplete removal of nevus by shaving or excision often stimulates the remaining tissue to proliferate, which is called a traumatically activated nevus. Regular follow-up is required.
One should always look for the following changes for melanocytic nevus as follows:
1. Change in color and irregular surface.
2. An increase in the size of the lesion.
3. Irregular margins.
4. Inflammation.
5. Bleeding, crusting, or oozing.
The treatment is complete excision along with the margins.
Hi doctor,
Thank you for your reply. I understand how it progresses. What I am asking is, based on my pathology report, why would a mole be mild-to-moderate upon biopsy and then labeled as severe when excised?
Hi,
Welcome back to icliniq.com.
The histopathology report indicates dysplastic nevus. I am sure you are aware of FAMMM, that is, familial atypical mole-malignant melanoma syndrome and classification for atypical nevi.
Mild to moderate to severe grading is for atypical cells. Since this atypia correlates clinically with darkening and confluence of pigment in the lesion, this grading has led to considerable confusion due to a lack of intraobserver concordance in the diagnosis. So, there can be variations in grading.
Once a biopsy taken from the lesion suggests mild to moderate grade, then it cannot turn into severe for atypical cells if it is not correlated clinically.
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