Is a Punch Biopsy Enough for a Dysplastic Nervus with Moderate Atypia?

While this is benign pathology there is a description of atypical cells.  Rexcision to obtain clear margins would be recommended to be safe. Ongoing monitoring of moles is advised.

Moderately dysplastic nevi (moles) should be excised. If the margins were clear, the punch biopsy would have been enough. But since the lesion extends to the margins, a simple re-excision should be performed.

In my practice, I routinely excise (cutting with sutures) a lesion (or the biopsy site of where the lesion was sampled)  that histologically displays "moderate atypia" and "extends to the peripheral specimen margin." The excision should be conservative as to spare healthy tissue but adequate so as to achieve clear margins.  Once a patient has a "dysplastic" or "atypical" mole, I recommend full body skin exams twice yearly (every 6 months). At this time, I suggest you consult with a well-trained, board-certified dermatologist to further treat this lesion and to do your twice yearly skin exams with. 

Although biologically benign, most doctors agree that it is best to remove dysplastic nevi. A punch biopsy is only used for diagnosis but not treatement unless the lesion is so tiny that it is completely removed with the punch and does not come to the margin.

We routinely excise nevi with moderate or severe atypia in our practice until there are clear margins.  If we get a report back that states the lesion goes to the edge of the specimen, we would re-excise it.

In our office, we will do an excision with suture closure to get clear margins for all moles that have moderate to severe atypia. As your growth was found to extend to the peripheral margin, there is still some of the mole remaining that needs to be removed. These are considered to be precancerous growths and conservative treatment is wise. We also follow all of our "atypical mole" patients by doing full skin examinations every six months. I recommend you see a board certified dermatologist for both your surgery options as well as your follow-up examinations twice yearly. 

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!