Virginia Beach Mole Removal doctors

This is somewhat in a gray area and opinions will vary among dermatologists. While all dermatologists would agree that a mole described as severely atypical warrants a total excision, therapeutic strategies regarding those interpreted as being moderately atypical varies. I personally will re-excise a nevus which has been called moderately atypical.  The procedure is simple and has low morbidity. If there is a family history of melanoma, the reasons for excision become even more compelling. Further the peace of mind we give our patients with a complete excision is also important. 

Be sure, that you practice self examination, inform your family doctor of this result and have follow up visits with your dermatologist.

Possibly by your next visit he/she will be using the Melafind device. This was recently approved by the FDA, and using computerized dermascopy, will allow us much greater accuracy in mole detection.

In other words a dysplastic nervus....would make me nervous...so off it goes!

How to proceed in a patient whose mole's biopsy report has been diagnosed as mildly atypical, depends on the philosophy of the dermatologist.

Atypia can be either architectural or cellular. Architectural disorder means that there are some irregular features in the general shape and configuration of the mole. Cellular atypia means that some of the cells may have a nucleus that is too large for the size of the cell, or the nucleoli look off-color. Cellular atypia is more serious than architectural disorder. 

 Many dermatologists will consult with the pathologist. If the pathologist is confident that the mole will not behave badly, he/she may advise us to leave the mole alone, that no further surgery is necessary.  These dermatologists will request that the patient return if there is a sign of pigment recurring.  Some dermatologist are not comfortable with this approach, and will excise the entire mole. 

I prefer an excision of an atypical mole rather than a punch biopsy.  I feel there is a better cosmetic result, especially on the larger excisions. I disagree with the PA that the punch biopsy goes deeper; the depth of the excision and the depth of the punch biopsy would  be the same. However, if the punch biopsy is well around the scar of the mole, and the pathology as returned that there are no residual nevus cells, then, otherwise it would not matter.

One other thing. I find nothing wrong with a PA examining you first. However, I hope that a dermatologist followed up this examination. There are too many practices where a PA is acting as a dermatologist...not with the goal of improving medical care, but for the economic benefit of the dermatologist. If the PA examined you and THEN the dermatologist, that is fine, since four eyes can be better than two. 

In regards to the shave, I would assume that your pigmented lesions drew little suspicion of a melanoma. In such cases a shave biopsy can be safely performed. The vast majority of melanomas begin high up in the skin. However, if a melanoma is suspected, either a saucerization technique ( essentially a deep shave) or a total excision should be done, not a superficial shave biospy. Dr. June Robinson showed in a paper in 2008, that a saucerization technique was as effective as an excision. In some cases, with a large atypical pigmented lesion such as a lentigo maligna ( Hutchinson's freckle), this method  may even be preferred. 

The darkening of your mole is most likely due to what we call post-inflammatory hyper-pigmenttion. This is due to the pigment in the mole dropping off into the dermis and causing increased pigmentation. 

However, it is prudent to consult a dermatologist for darkening of any mole, especially if herpes labialis was a self-diagnosis. After all the "C" in the A B C D E of melanoma detection stands for "color change".