Conservative Margins on Severe Atypia normal?

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  • Post
    • January 26, 2012 at 4:16 pm
    CCarolina
    Participant

      Hi everyone,

      Hi everyone,

      I am probably just being paranoid, but I recently had two mole biopsies, and one came back as severely atypical and the other one came back as moderately atypical.  Last time (5 years ago) I had a moderately atypical mole my dermotologist re-excised the punch biopsy.  This time I only had a shave biospy, but this derm only wants to conservatively excise the severely atypical mole (1mm) and not do anything with the moderate one (which is on my back where I can't see it).  In addition, from what I can tell from the pathology report (thanks to everyone who posted on this blog, I realized it was somethingIi should request tosee!) it looks like the pathologist couldn't for sure rule out melanoma.  Anyway, I was just wondering if times have changed and my new dermotologist's stance is the new normal treatment for severe and moderate atypia?

      Here's what the pathology report says:

      1.  Junctional Lentiginous dyspastic nevus with severe atypia.  There is a junctional and lentiginious poliferation of melanocytes with a marked degree of melanocytic aytipia.  There are occasional small microtheques.  Individual cells focally extend upward into the epidermis as single cells in a pagetoid pattern.  The underlying dermis has fibroplasia and lymphocytic host reponse.  There are scattered macrophanges.  This pattern borders on early evolving melanoma in situ but is not diagnostic in this specimen.  There is fibroses in this nevus so that it is difficult to determine whether some of the atypia is related to the dysplaia or whether some of these changes may represent a recurrant or persistant nevus effect in a previously traumatized melancytic nevus.  The margin sin these sections are so close to the lesion that I cannot assure you that the lesion is removed.

      2.  Dysplastic compound nevus with moderate melancytic atypia.  Melanocytes are present at the junction and within the dermis.  There is an aberrant architecture with associate stromal fibroplasi and a lymphocytic host response.  Upward growth of single cells is not conspicuous but there is moderate atypia of the melancytic cells.  The margin is sufficiently close that I cannot assure oyu that the lesion is removed.

      Anyway, I am probably just being paranoid, but I would appreciate any advice you can give!

    Viewing 11 reply threads
    • Replies
        • January 26, 2012 at 4:35 pm
        Janner
        Participant

          In general, severe atypia requires 5mm margins.  It is typically treated the same as melanoma in situ as the two can be difficult to distinguish.  It's actually better (insurance wise) to have a severely atypical lesion than melanoma in situ but I'd definitely request 5mm margins.  Since the lesion may not have even clear margins now, I'd definitely ask for the full 5mm margins.

          Moderate atypia doesn't seem to have any real standards.  Some just want clear margins, other want conservative (2-3mm) margins.  I'd definitely want at least clear margins which you don't know if you have now.  But as long as he is excising, maybe get that little extra for peace of mind.

          I don't think you are being paranoid at all.  You are being proactive in your care and trying to make informed decisions.

          Best wishes,

          Janner

          • January 26, 2012 at 4:35 pm
          Janner
          Participant

            In general, severe atypia requires 5mm margins.  It is typically treated the same as melanoma in situ as the two can be difficult to distinguish.  It's actually better (insurance wise) to have a severely atypical lesion than melanoma in situ but I'd definitely request 5mm margins.  Since the lesion may not have even clear margins now, I'd definitely ask for the full 5mm margins.

            Moderate atypia doesn't seem to have any real standards.  Some just want clear margins, other want conservative (2-3mm) margins.  I'd definitely want at least clear margins which you don't know if you have now.  But as long as he is excising, maybe get that little extra for peace of mind.

            I don't think you are being paranoid at all.  You are being proactive in your care and trying to make informed decisions.

            Best wishes,

            Janner

              • January 26, 2012 at 5:36 pm
              CCarolina
              Participant

                Hi Janner,

                Thanks so much for the advice!  Do you have any idea why she wants to do only 1mm margins on severe atypia?  It seems not to be the norm at all.   If I don't care about the scar, I'm not sure why she would!

                Thanks again!

                CCarolina

                • January 26, 2012 at 5:36 pm
                CCarolina
                Participant

                  Hi Janner,

                  Thanks so much for the advice!  Do you have any idea why she wants to do only 1mm margins on severe atypia?  It seems not to be the norm at all.   If I don't care about the scar, I'm not sure why she would!

                  Thanks again!

                  CCarolina

                  • January 26, 2012 at 5:43 pm
                  Janner
                  Participant

                    I'd say her goal is to get clean margins only – hence the 1mm margins.  However, that really isn't the standard.  I'd ask her the rationale, but I'd also demand 5mm margins.  Let her know that the most conservative approach isn't your approach.  As with any biopsy/excision, continue to watch the scar area for any pigment regrowth and report it to your doctor.

                    Best wishes,

                    Janner

                    • January 26, 2012 at 5:43 pm
                    Janner
                    Participant

                      I'd say her goal is to get clean margins only – hence the 1mm margins.  However, that really isn't the standard.  I'd ask her the rationale, but I'd also demand 5mm margins.  Let her know that the most conservative approach isn't your approach.  As with any biopsy/excision, continue to watch the scar area for any pigment regrowth and report it to your doctor.

                      Best wishes,

                      Janner

                      • January 26, 2012 at 5:43 pm
                      Janner
                      Participant

                        I'd say her goal is to get clean margins only – hence the 1mm margins.  However, that really isn't the standard.  I'd ask her the rationale, but I'd also demand 5mm margins.  Let her know that the most conservative approach isn't your approach.  As with any biopsy/excision, continue to watch the scar area for any pigment regrowth and report it to your doctor.

                        Best wishes,

                        Janner

                        • January 26, 2012 at 6:08 pm
                        CCarolina
                        Participant

                          Thanks so much for your help, Janner! I will definitely be talking to her about it.  Better safe than sorry!

                          CCarolina

                          • January 26, 2012 at 6:08 pm
                          CCarolina
                          Participant

                            Thanks so much for your help, Janner! I will definitely be talking to her about it.  Better safe than sorry!

                            CCarolina

                            • January 26, 2012 at 6:08 pm
                            CCarolina
                            Participant

                              Thanks so much for your help, Janner! I will definitely be talking to her about it.  Better safe than sorry!

                              CCarolina

                              • January 26, 2012 at 5:36 pm
                              CCarolina
                              Participant

                                Hi Janner,

                                Thanks so much for the advice!  Do you have any idea why she wants to do only 1mm margins on severe atypia?  It seems not to be the norm at all.   If I don't care about the scar, I'm not sure why she would!

                                Thanks again!

                                CCarolina

                              • January 26, 2012 at 4:35 pm
                              Janner
                              Participant

                                In general, severe atypia requires 5mm margins.  It is typically treated the same as melanoma in situ as the two can be difficult to distinguish.  It's actually better (insurance wise) to have a severely atypical lesion than melanoma in situ but I'd definitely request 5mm margins.  Since the lesion may not have even clear margins now, I'd definitely ask for the full 5mm margins.

                                Moderate atypia doesn't seem to have any real standards.  Some just want clear margins, other want conservative (2-3mm) margins.  I'd definitely want at least clear margins which you don't know if you have now.  But as long as he is excising, maybe get that little extra for peace of mind.

                                I don't think you are being paranoid at all.  You are being proactive in your care and trying to make informed decisions.

                                Best wishes,

                                Janner

                                • January 26, 2012 at 9:21 pm
                                SoCalDave
                                Participant

                                  Always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                  Dave

                                  • January 26, 2012 at 9:21 pm
                                  SoCalDave
                                  Participant

                                    Always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                    Dave

                                    • January 26, 2012 at 9:21 pm
                                    SoCalDave
                                    Participant

                                      Always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                      Dave

                                      • January 26, 2012 at 9:22 pm
                                      SoCalDave
                                      Participant

                                        In the future, always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                        Dave

                                        • January 26, 2012 at 9:22 pm
                                        SoCalDave
                                        Participant

                                          In the future, always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                          Dave

                                          • January 26, 2012 at 9:22 pm
                                          SoCalDave
                                          Participant

                                            In the future, always insist on a punch – once you've had mel never do a shave biopsy. Insist on the punch.

                                            Dave

                                            • January 26, 2012 at 9:47 pm
                                            jimjoeb
                                            Participant

                                              I just had a biopsy with the pathology showing severe atypia. The pathologist and my dermatologist recommend 5mm. I see the plastic surgeon on Feb 1.

                                              • January 26, 2012 at 9:47 pm
                                              jimjoeb
                                              Participant

                                                I just had a biopsy with the pathology showing severe atypia. The pathologist and my dermatologist recommend 5mm. I see the plastic surgeon on Feb 1.

                                                • January 26, 2012 at 9:47 pm
                                                jimjoeb
                                                Participant

                                                  I just had a biopsy with the pathology showing severe atypia. The pathologist and my dermatologist recommend 5mm. I see the plastic surgeon on Feb 1.

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