atyicpical intraepdiermal melanocytic

My biospy on a very small irregular shaped freckle on my right shoulder that I found 4 months after a skin screening:  "atypical intraepidermal melanocytic proleferation.  The lesion extends to a peripheral sugical margin."  A comment was listed below "While extremely small (suggeing melanocytic nevus), this melanocytic profliferation exhibits scatter of solitary, cytologically atypcial melanocytes throughout the enitrety of the epidermis (favoring the diagnosis of an early evolving malignant melanoma in situ)  My question is when I asked the doctor how he was sure it was melanoma insitu vs. a normal mole he first said that technology didn't exist to be sure given the small size, but it was his "gut feel" is it was melanoma in situ, in your opinion can a doctor really make such a declarative statement based on what he saw?  Is it ever true, and if yes, how often, does a atypical melanocytes NOT turn into anything?  HOw concerned should I be?

[Alan Rockoff, MD]

Your question has no definitive answer.  We can only make suppositions about the biologic behavior or a spot based on interpretation of the pathologist.  You clearly need to have more normal skin taken off around the spot as a precaution.  The question is how much.  I suggest that your doctor get opinions from other pathologists by sending the skides around to a couple of melanoma experts.  Then the two of you can out the opinions together and make a judicious choice.

Sometimes tests aren't as clear-cut as we'd like.

Take care.

Dr. Rockoff