Moderate Atypia. Is It Melanoma?

I am almost 22 and have been tanning in beds since I was in a preteen. (I won't be anymore) I got the results back from a biopsy and the mole was "moderate atypia." I have to go back in a couple weeks so my Dr can remove the skin around where they cut out my mole on my stomach. They said I would get stitches from this. Does this term "moderate atypia" mean I have cancer? What does it mean? Will I have a big scar from this next procedure where they remove more skin around it? Should I be worried?

Doctor Answers 15

Moderately atypical mole and Melanoma

Many skin pathologists (dermatopathologists) classify atypical moles or dysplastic nevi as having mild, moderate, or severe atypia. Unfortunately this classification system is very subjective and pathologists looking at the same specimen will often disagree on the level of atypia.

One approach is to not use this confusing language and to call all of these lesions “Clark’s nevi.”
So, to answer your question: An atypical mole with moderate atypia is not melanoma. It does not mean that mole is “pre-melanoma.” You may not have to have it re-excised.

We do not remove these moles further and we tell the patient that the mole is benign.

We do worry if the report says a dysplastic nevus has “severe atypia” or if the report says that the mole is a “Clark’s nevus with unusual features.” In both cases, the pathologist should explain what those worrisome features are and whether or not he/she thinks the lesion is an early evolving melanoma.

An article in the Journal of the American Academy of Dermatology in 2010 suggested that dysplastic nevi with mild or moderate atypia may not need to be removed.

Skokie Dermatologist

A moderately atypical mole is not melanoma, but should be removed.

Do not panic. "Moderate atypia" in a mole means that some of the cells have started to behave abnormally, and it is more than "mild" but not "severe". Melanoma is a mole that is "beyond severely abnormal", but you do not want to leave the remaining portion or border of a moderately atypical mole in your skin, because over time the remaining cells can continue to change, and it is very hard to follow visually. Best to have a small excision with stitches, get clear margins, and learn to watch future changing moles and bring them to your dermatologist's attention. It is also important, especially for someone with a history of tanning and changing moles, to get an annual head to toe skin cancer and mole check by a board-certified dermatologist (your annual physical with your internist does not count).

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Moderately Atypical Nevi are controversial...

Your questions are very good ones.  In short, moderately atypical nevi (moles) are not cancerous.  When you get the lesion removed, the scar should be slightly larger than your biopsy scar.  Usually these are excised and closed in a linear fashion; so you should just have a fine line for a scar (with the length determined by  the size of the mole). 

Atypical nevi (moles) are very controversial lesions.  I would say the most dermatopathologists don't believe that they are "pre-cancerous" anymore.   The main thought is that having these lesions means that you are at a higher risk for developing a melanoma at another site.  Melanomas can develop from atypical nevi, but this is not how they usually come up.  Melanomas usually arise de novo (they come up from no preexisting lesion). 

Different dermatologists and dermatopatholgists manage atypical nevi in many fashions.  Personally, if I see mild atypia, I usually just watch the lesion.  If it is moderate, I usually talk to the dermatopathologist for his/her opinion on removal.  If it is severe atypia, it is getting cut off.  Other dermatologists watch these lesions, and other dermatologist cut out even the mildly atypical ones. 

Atypia means that the nevus cells have an atypical appearance themselves (cytologic atypia) or are arranged in an atypical pattern (architectural atypia).  It does not necessarily mean that these cells are cancerous.

Should you be worried?  Well you don't have to worry that you have cancer right now.  Use this as a warning to be very diligent with you sun protection from this point forward.  Also perform regular self-skin exams and get regular examinations from your dermatologist. 

Brent Spencer, MD
Frisco Dermatologic Surgeon
5.0 out of 5 stars 1 review

Atypical moles are important

Great question- and you are right to be avoiding tanning beds from now on.  Atypical moles are neither cancer nor regular moles.  Controversy exists as to whether they are "pre-cancers" or simply a sign that someone is at higher risk for skin cancer.  Under the microscope, cancers are seen developing within these lesions, so I agree with your plan to have the mole completely removed so that you do not have to worry about it.  The size of the scar depends on many things and is an individual outcome which can not necessarily be predicted ahead of time.  Regarding the degree of atypia, "moderate" is right in the middle.  Severe means that the mole looks almost as bad as a skin cancer under the miscroscope, mild means it is barely atypical- almost like a regular mole.  Since yours is in between, it's a good idea to remove it, to avoid tanning and to have regular skin checks.

Victoria W. Serralta, MD
Arlington Dermatologic Surgeon
5.0 out of 5 stars 1 review

Moderate atypic

This is not cancer, but is abnormal and if left untreated could become cancer in the future. Your should discuss further treatment with your doctor. Dr Steve Merten, Sydney, Australia

Steve Merten, FRACS
Sydney Plastic Surgeon
4.9 out of 5 stars 48 reviews

Atypical mole

The answers no, you do not have cancer.  There may be a small risk of malignant transformation over time, but the vast majority of these nevi will never turn into cancer, either.  They are common and generally not terribly medically worrisome, but having many dysplastic nevi is a marker for a higher risk of developing melanoma in the future. This lesion should be treated by complete removal, rather than a biopsy or partial shave excision.  Then you should be seen regularly by a dermatologist.  

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 26 reviews

Dysplastic mole with moderate atypia: what do to?

I am quite surprised of the overwhelming and unilateral opinion that moderately atypical moles should be removed. Scientifically, moderately atypical moles may have a relatively benign course similar to mildly atypical nevi. Current recommendations do not necessarily support removal (see reference below). Despite this, many Physicians (100% of those who answered at the time of this response) recommend removal a lack of clear evidence supporting such. 

To clarify, the above should not be confused with moles with "moderate-to-severe" atypia and those with "severe" atypia, where excision should be considered and discussed with patients. 

The following is a quote from the article referenced below:
In cases of moderately dysplastic nevi, our study data suggest the possibility of generally benign behavior that may be similar to that of mildly dysplastic nevi. This evidence supports the commonly accepted management method of periodic observation for mildly dysplastic nevi with a positive margin, and suggests that observation represents a similarly reasonable option for moderately dysplastic nevi. Reliable evidence for most mildly or moderately dysplastic nevi behaving as true precursor lesions progressing to melanoma at a higher rate than typical benign nevi remains lacking or insufficient.

Each case should be individualized and discussed with the patient as no clear-cut standards exist.  Clearly, the current risk tool that is available (classifying as mild, moderate, moderate-to-severe, and severe) is not ideal and a better, more concise system needs to be developed. Those who opt to observe should be monitored regularly by a Dermatologist in addition to performing self-examinations. Those who opt to remove these moles may not have a significantly different outcome, although the procedure is fairly simple. 

Robert S. Bader, MD
Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

No one really knows

The world is grey - at one end of the spectrum are completely normal moles (Cindy Crawford, Clint Eastwood, Marilyn Monroe) and at the other end of the spectrum is melanoma, a very deadly cancer that often affects all ages.  Atypical or dysplastic moles are in that grey zone in the middle.  Some experts declare that these atypical moles are just funny and will always stay that way.  Other experts state that they are "premelanoma", and if left untreated will progress to melanoma. More evidence is showing that moderately and severely atypical moles can progress to melanoma so the consensus at this time is to conservatively remove moderately and severely atypical moles with small margins.  It is better off your body!

Jennifer T. Haley, MD, FAAD
Scottsdale Dermatologist
5.0 out of 5 stars 7 reviews

Removing atypical moles or revision of atypical mole biopsies

Atypia is a staging tool that is used to gauge the extent of abnormal cells in the skin biopsy. Although atypia is not considered cancer, it warrants immediate attention. 

Raffy Karamanoukian MD FACS
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Moderate Atypia and skin cancer

When the pathologist who reads your biopsy they grade the moles on how atypical they are.  Moles can be slightly atypical, moderately atypical, or severely atypical.  Generally the dermatopathologist who examined the slides of your biopsy will recommend to the clinician (your dermatologist) what kind of removal is indicated.  If they think it is not too serious they will recommend a deep shave removal.  If the pathologist is more concerned about the cells in the mole they will recommend a surgical excision.  Please seek out a board certified dermatologist who is associated with an excellent laboratory for the best results.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.