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Mildly Atypical Mole With Positive Margins

Forums General Melanoma Community Mildly Atypical Mole With Positive Margins

  • Post
    Jgerig84
    Participant

      I recently had a biopsy done of a small (3mm) mole on my calf. The pathology came back as "dysplastic nevus with mild atypica that extends to both  peripheral margins". My derm told

      me I could "wait and watch for repigmentation" or choose to have more taken in an effort to get clean margins. I have no personal history with Melanoma but my mother died of melanoma when I was 4 years old so it's a point of anxiety for me. I decided to have more taken. I had my appt this morning and the surgeon seemed to have terrible bedside manner… I was asking how large the scar would be and I think her thought I was getting cold feet so he started to tell me things that were scary to me. He told me that the re-excision wasn't just to "get all the cells" but to officially rule out melanoma. He told me that this could still be melanoma and that there is no way to know for sure until they get all the cells. He said that the pathologist graded it as "mild" but he could've been wrong or there could have been melanoma that extended past the actual mole that he couldn't see. He then preceded to tell me that he has worked on patients who were originally told "mild atypical" and were upgraded to melanoma after re-excision. I was freaking out so of course I let him do it. He did a punch biopsy this time and was saying he was sure he got all the cells. As he was cleaning me up he started telling me that the chances of a "mild" coming back after re-excision as melanoma was probably less than 1%…. I don't understand why he made it seem so scared prior to excision and then basically told me chances were low afterwards. Now, the damage has been done and I'm terrified…. please help.

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    • Replies
        Janner
        Participant

          I think he's nuts.  Maybe if only a partial biopsy of a large lesion was done, you might have something more sinister in a different part.  But when the entire mole was removed (even with involved margins) and the mole was mildly atypical, the chances that anything is melanoma is just not really there.  Of course no one can say it would never happen.  But if the original biopsy was read by a dermatopathologist, there is just no way those remaining cells would be melanoma.  I HATE scare tactics and people who perpetuate that.  Now if the lesion were severely atypical, that could be a different story.

          The remaining tissue is unlikely to show ANY melanocytes and definitely no melanoma.  Relax.  Chalk it up to a surgeon who should keep his mouth shut – maybe more used to cutting on those under general anesthesia where they can't hear him.

            Jgerig84
            Participant

              Thank you Janner!

              Melanoma is my biggest fear. When I was 4 years old it claimed my mothers life in 7 months…. now that I am a mother, I try to stay on top of my skin to make sure the same thing doesn't happen to me. I need to be here for my daughters. The surgeon just really scared me this morning. I did a lot of online research and found that many, if not most, people with mild atypical legions tend to watch and wait. I even read that a lot of derms consider mild results benign and not a major cause for concern. So I thought I was being very proactive by electing to make sure we had clear margins but then he just filled me with fear. He even told me a story of a woman who had a mild reported on pathology and came in to re-excise and it was later determined that the original pathology was misread and it was actually invasive melanoma. Why would you tell someone THAT story while cutting into their leg?? I'm sure there are crazy exceptions that doctors run into when they been doing this long enough but I'm just don't sure those are the stories that should be shared with an already anxious patient. Now I'll be terrified for the next 2 weeks while I wait for pathology results.

              Janner
              Participant

                My derm chooses to excise any atypical cells so I agree you were just being proactive.  Mildly atypical is about as benign as it can be with some little weirdness going on — I don't give them a second thought!    Given your history, I think it is perfectly fine to ask for the excision.  But the surgeon was out of line.  Again, most re-excisions don't show ANY melanocytes at all (even when margins were involved) and, if there happen to be any, they won't be melanoma.

                Jgerig84
                Participant

                  My regular derm called to check on me yesterday and I told her about my experience with the surgeon. She was so upset that he had scared me so much. She explained that while he is a great surgeon, he tends to be extreme and "cut happy". She was familiar with the story he told me about the girl with a "mild atypical" biopsy result that was diagnosed with Mel upon re-excision but assured me that was almost 20 yrs ago and that the practice hasn't seen anything like that since. She also said that the original path on that case was read wrong and they were suspicious from the start… much different than my situation. She also told me that she personally, has never had a mild or moderate come back with a worse diagnosis than it went out with and that the surgeon was giving me the very worst case  scenario. She said, is it possible?? Yes. Is it likely??? Absolutely not. She compared it with going to the urgent care because you've had an upset stomach for a few days and instead of the doctor telling you that you probably have a stomach virus, he tells you it could be a parasite eating you from the inside out… possible yes but EXTREMELY unlikely. I felt much better after I spoke with her. While I'm still nervous, I feel calmer.

                  Jgerig84
                  Participant

                    My regular derm called to check on me yesterday and I told her about my experience with the surgeon. She was so upset that he had scared me so much. She explained that while he is a great surgeon, he tends to be extreme and "cut happy". She was familiar with the story he told me about the girl with a "mild atypical" biopsy result that was diagnosed with Mel upon re-excision but assured me that was almost 20 yrs ago and that the practice hasn't seen anything like that since. She also said that the original path on that case was read wrong and they were suspicious from the start… much different than my situation. She also told me that she personally, has never had a mild or moderate come back with a worse diagnosis than it went out with and that the surgeon was giving me the very worst case  scenario. She said, is it possible?? Yes. Is it likely??? Absolutely not. She compared it with going to the urgent care because you've had an upset stomach for a few days and instead of the doctor telling you that you probably have a stomach virus, he tells you it could be a parasite eating you from the inside out… possible yes but EXTREMELY unlikely. I felt much better after I spoke with her. While I'm still nervous, I feel calmer.

                    Jgerig84
                    Participant

                      My regular derm called to check on me yesterday and I told her about my experience with the surgeon. She was so upset that he had scared me so much. She explained that while he is a great surgeon, he tends to be extreme and "cut happy". She was familiar with the story he told me about the girl with a "mild atypical" biopsy result that was diagnosed with Mel upon re-excision but assured me that was almost 20 yrs ago and that the practice hasn't seen anything like that since. She also said that the original path on that case was read wrong and they were suspicious from the start… much different than my situation. She also told me that she personally, has never had a mild or moderate come back with a worse diagnosis than it went out with and that the surgeon was giving me the very worst case  scenario. She said, is it possible?? Yes. Is it likely??? Absolutely not. She compared it with going to the urgent care because you've had an upset stomach for a few days and instead of the doctor telling you that you probably have a stomach virus, he tells you it could be a parasite eating you from the inside out… possible yes but EXTREMELY unlikely. I felt much better after I spoke with her. While I'm still nervous, I feel calmer.

                      Janner
                      Participant

                        My derm chooses to excise any atypical cells so I agree you were just being proactive.  Mildly atypical is about as benign as it can be with some little weirdness going on — I don't give them a second thought!    Given your history, I think it is perfectly fine to ask for the excision.  But the surgeon was out of line.  Again, most re-excisions don't show ANY melanocytes at all (even when margins were involved) and, if there happen to be any, they won't be melanoma.

                        Janner
                        Participant

                          My derm chooses to excise any atypical cells so I agree you were just being proactive.  Mildly atypical is about as benign as it can be with some little weirdness going on — I don't give them a second thought!    Given your history, I think it is perfectly fine to ask for the excision.  But the surgeon was out of line.  Again, most re-excisions don't show ANY melanocytes at all (even when margins were involved) and, if there happen to be any, they won't be melanoma.

                          Jgerig84
                          Participant

                            Thank you Janner!

                            Melanoma is my biggest fear. When I was 4 years old it claimed my mothers life in 7 months…. now that I am a mother, I try to stay on top of my skin to make sure the same thing doesn't happen to me. I need to be here for my daughters. The surgeon just really scared me this morning. I did a lot of online research and found that many, if not most, people with mild atypical legions tend to watch and wait. I even read that a lot of derms consider mild results benign and not a major cause for concern. So I thought I was being very proactive by electing to make sure we had clear margins but then he just filled me with fear. He even told me a story of a woman who had a mild reported on pathology and came in to re-excise and it was later determined that the original pathology was misread and it was actually invasive melanoma. Why would you tell someone THAT story while cutting into their leg?? I'm sure there are crazy exceptions that doctors run into when they been doing this long enough but I'm just don't sure those are the stories that should be shared with an already anxious patient. Now I'll be terrified for the next 2 weeks while I wait for pathology results.

                            Jgerig84
                            Participant

                              Thank you Janner!

                              Melanoma is my biggest fear. When I was 4 years old it claimed my mothers life in 7 months…. now that I am a mother, I try to stay on top of my skin to make sure the same thing doesn't happen to me. I need to be here for my daughters. The surgeon just really scared me this morning. I did a lot of online research and found that many, if not most, people with mild atypical legions tend to watch and wait. I even read that a lot of derms consider mild results benign and not a major cause for concern. So I thought I was being very proactive by electing to make sure we had clear margins but then he just filled me with fear. He even told me a story of a woman who had a mild reported on pathology and came in to re-excise and it was later determined that the original pathology was misread and it was actually invasive melanoma. Why would you tell someone THAT story while cutting into their leg?? I'm sure there are crazy exceptions that doctors run into when they been doing this long enough but I'm just don't sure those are the stories that should be shared with an already anxious patient. Now I'll be terrified for the next 2 weeks while I wait for pathology results.

                            Janner
                            Participant

                              I think he's nuts.  Maybe if only a partial biopsy of a large lesion was done, you might have something more sinister in a different part.  But when the entire mole was removed (even with involved margins) and the mole was mildly atypical, the chances that anything is melanoma is just not really there.  Of course no one can say it would never happen.  But if the original biopsy was read by a dermatopathologist, there is just no way those remaining cells would be melanoma.  I HATE scare tactics and people who perpetuate that.  Now if the lesion were severely atypical, that could be a different story.

                              The remaining tissue is unlikely to show ANY melanocytes and definitely no melanoma.  Relax.  Chalk it up to a surgeon who should keep his mouth shut – maybe more used to cutting on those under general anesthesia where they can't hear him.

                              Janner
                              Participant

                                I think he's nuts.  Maybe if only a partial biopsy of a large lesion was done, you might have something more sinister in a different part.  But when the entire mole was removed (even with involved margins) and the mole was mildly atypical, the chances that anything is melanoma is just not really there.  Of course no one can say it would never happen.  But if the original biopsy was read by a dermatopathologist, there is just no way those remaining cells would be melanoma.  I HATE scare tactics and people who perpetuate that.  Now if the lesion were severely atypical, that could be a different story.

                                The remaining tissue is unlikely to show ANY melanocytes and definitely no melanoma.  Relax.  Chalk it up to a surgeon who should keep his mouth shut – maybe more used to cutting on those under general anesthesia where they can't hear him.

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