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?
Moderate Atypia. Is It Melanoma?
Doctor Answers 14
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).
Moderately atypical mole and Melanoma
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.
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.
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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.
Dysplastic mole with moderate atypia: what do to?
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.
No one really knows
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