Moderate Atypia. Is It Melanoma?

Question

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?

Steve Merten, FRACS - Account Suspended · Answer

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

Jeffrey D. Wagner, MD · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

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 FACSLos Angeles

Robert S. Bader, MD, FAAD · Answer

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.SUMMARY: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.

Harry Goldin, MD · Answer

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.

Jennifer T. Haley, MD, FAAD · Answer

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!

Michele S. Green, MD · Answer

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.

Edward E. Dickerson, IV, MD · Answer

No, Moderate Atypia doesn't mean that you have cancer. It means that your mole if not
	removed has the potential to become malignant. Its good that you are having the       
	surrounding skin removed to insure there is no chance of developing skin cancer in the
	future.

	 

	"Dr.D"

Gary Goldenberg, MD · Answer

Dysplastic nevi (moles) are NOT melanoma. They are a marker for an increase in melanoma risk. Most melanomas (75%) arise from normal skin, not from pre-existing moles. However, if a mole is changing or growing, or if it looks different from other moles, it may be biopsied to rule ouy melanoma. If such a biopsy comes back as a dysplastic nevus with moderate, focal severe, or severe dysplasia, it needs to be excisied (completely removed or cut out) to make sure it doesn't turn into a melanoma later on.

Steven Turkeltaub, MD · Answer

Moderate atypia of a mole means that it is abnormal and must be removed. It does not represent a skin cancer but if left untreated, may progress into a melanoma.

	Tanning booth usage, particularly for a long time as you indicated, is notorious for leading to these atypical moles and even melanoma in addition to causing significant premature aging of your skin. Complete cessation of usage of tanning booths - and sun bathing is mandatory. You should also regularly use a high factor sun screen and minimize your sun exposure in the future.

	It would also be prudent to have a dermatologist check you on a regular basis.

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