Question: Hi,
I have a question regarding a mole. I had a mole biopsied back in May that came back as mild to moderately atypical. The description was as follows:
The specimen is a shave biopsy of skin present as multiple H&E stained sections on one slide. The pathologic process is that of a 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. 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.

They recommended that I have it excised which I did, but when that happened, it was upgraded to severely atypical and described as follows: The specimen is an excision of skin extending to and including subcutis that is present as multiple H&E stained sections on two slides. In Block A2 in particular, there is a severely atypical proliferation of melanocytes along the dermoepidermal junction and within the dermis. There is a biphasic quality to the lesion. There is atypia in the form of pleomorphism, hyperchromasia and irregular nuclear contour. The process frankly involves the lateral surgical edge. This is a concerning situation. In this re-excision, there is a severe atypia. It is possible some of this atypia is reactive. However, the process is incompletely excised and it extends to the lateral edge. Given the uncertain biologic potential of this lesion, timely conservative re- excision with histopathologic confirmation of complete removal is indicated. Check margins. Received in formalin is a 0.6x2.2x0.4 cm tan-gray excision of skin labeled with the patient's name and biopsy site. Margins inked in green. Serially Sectioned and submitted in two cassettes.

I am wondering if I should be worried about this being melanoma? Is it normal to have atypia in the dermis? Is that symptomatic of reactive atypia? They recommended that I get it re-excised, which I did. I am waiting to hear if the margins cleared.

Thank you - should I be worried about invasive melanoma if it's in the dermis? Also what are your thoughts on the atypia being graded higher because the mole is acting based on trauma? I had the happen once before - a benign mole grew back with increases atypia in the epidermis and the dermis. They said it was probably a pseudomelanoma but recommended it's complete removal which I did and that was that. Will the full excised lesion give me a more conclusive answer? I have had many compound moles with atypia in the dermis that have never been upgraded to melanoma - XXXX