Dysplastic Nevus

[moleman]

I'm a caucasion male, early 40’s, fair skin, blond hair, normal weight, and in good health.  No history of skin cancer in my family. I sunburn fairly easily and I got sunburned many times since childhood. I don’t smoke, I drink rarely and in moderation, and follow a healthy vegan diet (no animal products) for over 20 years. (I read that low fat diets have been shown to reduce the occurrence of non-melanoma skin cancer.)  



In 2001 I had about 7 moles removed. One of the moles was diagnosed by the pathology lab as Dysplastic Nevus.  The doctor then performed a re-excision. The biopsy on the re-excision tissue came back clean.



Pathological Diagnosis (2001):

Skin, right mid back T-7, slide consultation:

Lentiginous compound dysplastic nevus with minimal cytologic atypia



Microscopic Description:

Sections show skin with a proliferation of slightly enlarged melanocytes arranged as single units and as nests at the dermoepidermal junction and within the dermis.  There is bridging of rete ridges, dermal fibroplasias, proliferation of blood vessels, and a patchy infiltrate of lymphocytes and melanophages.  There is no evidence of malignancy in the sections examined.



In August 2006 I went back to the same doctor for an exam.  The doctor removed 3 moles.  (There were at least 4 other moles the doctor pointed out to me as candidates for removal, but I declined to have those removed at this time.  I have approximately 30 moles or more of varying size still on my body.)  



A mole on my back was removed and diagnosed by the pathology lab as “Compound Dysplastic Nevus”.



Pathological Diagnosis (2006):

Skin, right lateral back, T1, shave biopsy, slide consultation:

Compound Dysplastic Nevus with focal moderate cytologic atypia and congenital features,irritated, margins involved, see comment.



Comment:  

Consideration of a conservative re-excision is suggested, if clinically indicated.



Clinical Impression: R/O DN



Microscopic Description:

Sections show an apparent shave biopsy specimen of skin with a proliferation of small to slightly enlarged melanocytes arranged as single units and as nests at the dermoepidermal junction and within the dermis and allowing evidence of maturation.  There are dermal fibroplasias, edema, vascular ectasia and a perivascular and interstitial infiltrate of lymphocytes and melanophage.  There is no evidence of pagetoid migration.  Increased dermal mitotic figures are not seen.  There is moderate solar elastosis.  There is no evidence of malignancy in the sections examined.



The doctor wants me to come back in A.S.A.P. for re-excision.



QUESTIONS:



Regarding the dysplastic nevus I had removed in 2001, was re-excision really necessary and would you have recommended it?  



Regarding the dysplastic nevus I had removed in August 2006, is re-excision absolutely necessary and what would you recommend?



Do I really need to have every irregular or darkly pigmented mole removed?



Thank you for your time

[Alan Rockoff, MD]

Atypia means different things when used by different pathologists.  The current lesion does need to be re-excised--moderate atypia usually implies wanting to be certain that it's all out.



I continue to be perplexed by questioners who send me their lab tests and ask me what they mean.  Lab tests have to be interpreted in light of the clinical condition--that means by the doctor who ordered them.  If you're skeptical of that doctor's opinion, perhaps you should find another doctor you trust.  Interpreting biopsy reports out of context is likely to lead to distortion and confusion.



Dr. Rockoff