Pathology Report - Next Step?

Hi - brief history: I have had mm in-situ, my sibling has also had mm in-situ, I have over 100 moles, many slightly atypical. I've also had 25 or so biopsy's - all either benign or slightly atypical.

A recent biopsy result stated: Junction Nevus with Architectural Disorder: The examined margins are negative. This nevus exhibits an architectural disorder, one of several histologic counterparts of a clinically atypical nevus. Diagnostic invasive melanoma or pagetoid precancerous precursor of melanoma is not seen in the material. Familial Atypical Mole Syndrome cannot be excluded without clinical or familial correlation.

One dr.wanted to re-exise more tissue while two others thought it would be pointless, and said it is fine and the margins are clear.

I wanted your opinion on if I should have more tissue removed or if that would be overkill. I am extremely high risk for melanoma so I hate to take chances, but I already have many nasty scars. THanks!

[Alan Rockoff, MD]

Interesting question.  The pathology report puzzles me a bit.  In these parts (Boston), pathologists who describe "architectural disorder" usually specify how much disorder there is (mild, moderate, severe.)  If moderate or severe, they then follow with a suggestion, such as "Recommend complete removal."  Absence of such a suggestion implies that they don't think the mole is funy enough under the microscope to take off more of.  Just having some degree of disorder doesn't necessarily mean anything at all.

Your pathologist says it was just a disordered mole, then adds, "Diagnostic invasive melanoma or pagetoid precancerous precursor of melanoma is not seen in the material."  That seems unneccessary, and makes you think--"If it's OK, why add that stuff about its not being a melanoma?"

Rather than guess, I'd ask--ask your dermatologist to call the pathologist and ask whether he or she thinks the whole thing is sufficiently out or of it needs more taken around it.  (That's what I do when my pathologist is inscrutable.)

If your pathologist isn't sure, have the slides sent around for other opinions.  (Slides are more portable than you!)  There's no automatic need to take more tissue just because there was some degree of disorder.  And besides, with all your moles, this scenario is likely to repeat itself sooner or later.

Good luck.

Dr. Rockoff