coumpound nevus with moderate melanocytic atypia

[jennie317]

I recently had a mole removed from the inside of my belly button.  The mole became noticable about 1 year ago when I was pregnant.  I am not sure if it was always there.  My family practice physician thought it didn't look bad but since it was about as large as an erasure head, was brown with a little black in it and was in a hard spot to monitor she removed it. The mole was read by our 2 in-town pathologists as a dysplastic nevus vs invasive malignant melanoma.  Since they didn't agree it was sent to Mayo and read as a compound nevus with moderate melanocytic atypia.  They said "the atypical melanocytes are present in both the epidermis and superficial portions of the dermis.  The epidermal component consists of nests and single cells including possible regions of melanocytic confluence and moderate cytologic atypia. No definite pagetoid spread is observed.  The proliferation is noted to track down to the adnexal structures in some regions.  The dermal component consists of nests of atypical melanocytes showing very little maturation upon decent into the dermis.  No significant mitotic activity or lympocytic host response is seen."  The closest lateral margins were reported to 3mm away.  

My family practice doc just said to watch the area.  I am, of course, very disturbed by the words malignant melonoma.  Is a compound nevus with moderate melanocytic atypia the same as malignant melanoma?  Are these lesions staged like cancers?  Do I need further testing to see if this spread to lymph nodes?  What is a prognosis for further occurance at this site or others? What do I do now?

Thank-You,

Jennie317

[Alan Rockoff, MD]

It sounds as though the whole thing is out.  The people at Mayo didn't think it was a melanoma at all--moderate dysplasia means different things to different pathologists, but what it does not mean is melanoma.

I'm not sure what you mean when you say,"our 2 in-town pathologists as a dysplastic nevus vs invasive malignant melanoma."  Do you mean that one or both of them said they thought it was or could be malignant melanoma.  If they are general pathologists, I would feel quite comfortable going along with experts at Mayo and just watching it, as your doctor suggests.  If the pathologist who suspected melanoma was a skin pathologist, you may want to request that the slides be sent for another opinion to a melanoma pathology expert.  Slides are portable, so getting another opinion is easy.

Quite frankly, though, you already have a very reliable opinion that it wasn't a melanoma, so it's unlikely that you'd find out otherwise even if you choose to seek another opinion.

Take care.

Dr. Rockoff