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Dysplastic nevus requiring further excision?

My 8-year-old son just had two had moles removed.  He has had others removed in the past that have demonstrated mild and mild to moderate atypia.  His grandmother died of metastatic melanoma five years after removal of a stage 2 lesion and I, his mother, have dysplastic nevi,..one severe...removed.

The two moles came back as follows:
Lentiginous compound nevus with mild to moderate atypia.  The margins of the specimen appear to be clear in the plane of the section. The lesion extends near to one lateral margin of the specimen.  (This was on his right occipatal scalp.)

The other was an inflamed lentiginous junctional nevus with dermal melanosis.  The examined surgical margins of the nevus appear clear.  Dermal melanosis extends to the dep margin of the specimen.  A second swipe was taken which came back focal residual dermal melanosis no residual nevus identified.  Multiple sections prepared from the specimen show a small focus of dermal melanosis and mild chronic inflammation.  No residual junctional nevus is identified.

My understanding is that the second mole has been thoroughly removed.  I remain concerned about the first.  He had another removed a year ago on his left occipital scalp that required a second "swipe." which resolved things.  I have been told with mild to moderate atypia the margin taken on the current specimen is sufficient but if I would feel better, they can take another swipe.  

Given our family history, I am wondering what you would advise. I don't want him to have unnecessary procedures but I am concerned.  Thank you for your help.
1 Responses
Avatar universal
In my opinion another procedure would be unnecessary. Dysplastic nevi with mild (or even mild/moderate atypia can be watched clinically and no further surgery need be done. Also, scalp nevi in children can have some degree of atypia and are commonly mistaken for dysplastic nevi. If your son's biopsies were interpreted by a good board certified dermatopathologist, you have no reason to  be concerned. I am a board certified dermatopathologist.
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