Atypical Melanocytic Hyperplasia

3 years ago I had a freckle removed from my lip.  It had appeared several years prior, then changed somewhat, so I had a shave biopsy performed and the following came from pathology:

"Lip lower right.  Early atypical melanocytic hyperplasia.  The lesion is 0.5 mm away from the closest lateral margin.  

Centrally there are increased numbers of melanocytes along the basal epidermis showing upward intraepidermal pagetoid spread.  The cells show mild to moderate nuclear atypia & appear somwhat enlarged.  Melanophages & inflammatory cells made be found w/in the dermis.  In this instance the term "atypical melanocytic hyperplasia" is used to connote a lesion which has histologic features felt to reflect premalignant or incipient change of melanoma in a stage readily treated by conservative but complete excision."

My DR recommended Mohs surgery and it was performed.  I was told no "atypical" cells were found in what was taken.  Stitched up w/ a good cosmetic result.

Now 3 years later I notice another very, VERY faint freckle above the surgical site.  I am waiting for a second pathology report from a bit deeper shave biopsy.

My concerns:  I have no history of melanoma in my family.  I have a personal history of major hyperpigmentation from any skin trauma on my face...sun, a dermabrasion followed by a beta peel left a dark discoloration that will ever go away, I am told.  I have sun patches under my eyes.  I am fair skinned but tan well (although I ain't doing that anymore).

My DR called the first pathology report "melanoma in situ"...and I'm concerned..I have discoloration all over my face and on the margins of my lips that look exactly the same...the only difference is the other freckle DID change and darken slightly in the center.  But it doesn't/didn't look anything like the pictures of melanoma I can find in any cases.

Should I seek another opinion on these labs results regardless when they come back?  Are there treatments I could be doing for the sun damage/hyperpigmentation on my lips and face that no one is addressing?  If each has the potential to go into "atypical" and thus "melanoma in situ"...I'm frankly freaking...I wouldn't have a face left!

I was 36 at the original diagnosis.  Now am 39.  I have very few moles, and freckle at the shoulders slightly from sun.  The worse sun spots by far are on my face...under my eyes in particular...and then scattered.  Most appeared w/in the last five years (athough I now use sunscreen, I did my damage young).

Suggesions?  What exactly does this diagnosis mean?  Is it melanoma?!  No one seems to want to button anything down, and frankly the region in question is cosmetically sensitive - my lip!  

Thank you for any feedback you can provide ~*Linda

[Alan Rockoff, MD]

I understand your anxiety, but you are taking your concerns too far.  Just because you had one atypical lesion doesn't mean that every spot you get will be atypical.  (The same is true for a freckle that comes back in the same place.)  What you need is to work with a doctor you trust to look at your spots carefully on a regular basis and to test anything that looks worrisome.  That seems to be what your doctor is doing.

Most spots don't develop into anything.  You don't need to remove them preventively.  You just need regular watching.

Melanoma-in-situ is not melanoma.  It presumably might turn into it if left alone, which it won't because it was taken off.

If there is a teaching hospital with a Pigmented Lesion Clinic anywhere nearby, you might want to visit there to get an overview and proper counseling.  I do not advise your attempting to interpret your own pathology reports.

Good luck.

Dr. Rockoff

[paul1952]

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