Moderate Atypia. Is It Melanoma?

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. 

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.