Dr. Vinay Kumar
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Recently I had a mole that just felt funny. I went to my dermatologist and asked her to take a look. Given my history, she was on the fence about it but decided to remove it. I am blue-eyed, very fair, and my mother and maternal grandfather had melanoma.
She did a shave biopsy, and the results came back as follows: junctional nevus with severe cytologic atypia and architectural disorder, inflamed pigmentary incontinence, a concerning melanocytic process with borderline qualities. It was recommended that the mole be excised with 5mm margins which I had done a few weeks later.
I have two questions regarding this. First of all, my understanding is that melanoma can be tricky to diagnose in its earliest stages, so I am wondering if this could be melanoma. The word "borderline" in the report. ; is it a cause of concern?. My second question is whether I need to do anything more for this mole. It was excised 5mm on all sides, and the margins were clear. So, if it was an early melanoma, would there be any additional treatment?
Hi,
Welcome to icliniq.com.
I have evaluated your concerns, and you need to be applauded for your alertness. You have taken steps to manage the "funny" mole have been in the desired direction. You are correct that moles can be tricky to diagnose in the early stages. It so happens that they tend to be taken lightly, and by the time an individual seeks medical consultation, sometimes they have already invaded more areas. The term "borderline" in pathological reports indicate that:
1. Either all the expected changes are not present, or the ones seen in the submitted specimen are not clear-cut. Sometimes, the biopsied samples are not a true replica of the most advanced lesion segment, and the pathologist would comment upon what they see rather than what they would expect if another sample was examined.
2. Secondly, it could be because it was an early lesion, it may not have developed features of an advanced lesion.
However, the mention of atypia and pigmentary incontinence leave little scope for doubt concerning diagnosis. In my practice, I have seen that pathologists tend to be conservative in their opinion. You took the best step to get the lesions removed. Now you only have to remain a careful observer watching for any unexpected growth, similar lesion elsewhere, and follow up as advised by your doctor.
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