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    What does this pathology report indicate?

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Posted on Tue, 18 Jul 2017 in Skin Hair and Nails
Question: I have a question about a mole. I had a mole biopsied a few week back and the pathology report came back as: 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.

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." My question is 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.
doctor
Answered by Dr. Kakkar S. 2 hours later
Brief Answer:
Regarding atypical mole

Detailed Answer:
Hello. Thank you for writing to us

I am Dr. Kakkar (dermatologist). I have gone through your query and I have noted your concern.
They must have either found prominent cytological and/ or architectural atypia on frozen sections of margins during the excision Or may be they upgraded because the positive margins are more often found in severely dysplastic nevi than in mild to moderately dysplastic nevi. However, even a severely atypical nevus has 100% survival rate if excised with clear margins of surrounding normal skin.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 26 minutes later
Hi - thank you for your reply. That makes more sense to me. Should I be concerned that the cells are - per the pathology report - in the dermis as well as the epidermis? I've had many, many mildly atypical moles where the cells were also in the dermis. They recommended a re-exicision within three weeks - is that, in your opinion, sufficient?
doctor
Answered by Dr. Kakkar S. 17 hours later
Brief Answer:
Regarding atypical nevus

Detailed Answer:
Hi.

A nevus usually has both epidermal and dermal component therefore atypical cells may be present in epidermis as well as in dermis.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 1 hour later
My understanding is that a compound nevus has a dermal component where a junctional is more epidermis - is that correct? Also are atypical cells in the dermis of any concern or is that just what happens in dysplasia?
doctor
Answered by Dr. Kakkar S. 16 minutes later
Brief Answer:
Regarding atypical mole

Detailed Answer:
Hello.

Yes, you are correct.
Compound nevus has a dermal component and therefore a nevus with atypical epidermal and dermal nevus cells is an atypical compound nevus. Junctional nevi would have nevus cells at the junction of dermis and epidermal.
The normal evolution of a nevus is such that it begins as junctional and later progresses deeper to become compound and finally intradermal i.e the nevus cells move deeper.
The term 'Dysplasia' is used in reference to abnormal/ transformed nevus cells and they may be both epidermal and dermal in a compound nevus or only epidermal in a junctional nevus.
Not all atypical nevi are necessarily compound.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

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