Is Shave Biopsy Appropriate in this Case?

[amy21]

I have a family history of melanoma and over 100 moles on my body.  Recently, my GP suggested that I have a 1 mm black spot on my leg removed.  I have since found two other spots very similar (one is 1mm and the other 3mm) and have a very itchy irregular mole on my back (6 mm).  

The incisional biopsy showed:
"atypical junctional nevus with architectural disorder and severe cytologic atypia.  The margins are not involved in the place of section examined."

My GP wanted to incise the other moles, but I decided I should see a dermatologist, which I did.  The dermatologist is suggesting that he do a shave biopsy on the moles of concern.  My question is...everything I've read says that shave biopsy isn't such a great idea because if melanoma is present, it is difficult to stage if it's been shaved.  Is this correct?  Should I demand incisional biopsy?  I don't want to be a pain, but I'd rather err on the side of caution, especially given the "severely atypical" reading on the first mole.

Incidently, I've been trying to find out the cause for three months of left supraclavicular swelling, I have a new lump on my right thigh (probably a lipoma), I have a painful "bone fibroxanthoma" on my left clavicle (supposedly benign), and have been told I have some pleural thickening.  

My doctor is suggesting a Rhuematologist for the swelling and bone pain.  I have an appointment next week.

I'm 38 and otherwise very healthy, but I've become concerned about my other symptoms and want to make sure that something like melanoma isn't missed, especially given my family history and so many weird symptoms in the last six months.  

In my experience, doctors usually don't like questions.

Your advice?

[Alan Rockoff, MD]

A deep shave will give the information the pathologist needs.  Your other lumps and bumps seem unrelated.  A visit to a rheumatologist is a good idea.

I think for your moles that being followed by the dermatologist is a good idea, since he'll be judicious about which ones to biopsy and which to watch.  One severely atypical mole is not necessarily a sign that your others are a problem.

Best.

Dr. Rockoff

[amy21]

I saw the Rheumatologist and was told that I don't have a Rheumatologial condition.  I was told that my swelling and bone pain is likely from the bone tumor in my clavicle.  The Dr. thinks this is benign, but I've requested a biopsy (or removal if appropriate).  Night pain is unbearable.

I had the moles shaved...will get the results in a few more days.  I've been having pain in my right upper thigh and swelling in groin area.

I'm worried that this is all related.

Thoughts?

[Alan Rockoff, MD]

Can't think of any connection.

Dr. Rockoff