WLE for moderate dysplasia (Janner)
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WLE for moderate dysplasia (Janner)

› Forums › Cutaneous Melanoma Community › WLE for moderate dysplasia (Janner)

  • Post
    • June 21, 2017 at 7:54 pm
    dhwriter
    Participant
      I had my followup with the nurse practitioner today about excision of a biopsied moderate atypical mole. Here is the pathology report:

      MODERATELY DYSPLATIC COMPOUND MELANOCYTIC, EXTENDING TO THE PERIPHERAL EDGE

      Gross Description: The specimen received in formalin labeled with patient’s name and as “lower back left of midline” consists of skin measuring 0.5 x 0.5 x 0.1 cm. ES, 2y / 1bs

      Microscopic Description:

      Sections demonstrate skin with single cells and nests of moderately atypical melanocytes which bridge adjacent rete ridges. Within the dermis there is papillary dermal fibroplasia and an inflammatory host response. A dermal component of the nevus is present.

      Based on the report I was okay with a conservative excision. However the NP said she would be doing a WLE with 4mm margins. I decided to go with a 3 month observation of the area to see if anything recurs and then go from there. The mole was biopsied because it was offered by the NP, not because of any issues with mole. Had it since I was early 20s, possibly late teens, 34 now. No history of melanoma, family or otherwise.

      A 4mm margin WLE felt excessive, but she said it was standard for a 5x5mm biopsy. Does this sound right? I’ve read a small conservative excision should be enough.

      The NP seemed perfectly okay with observation. I’m just confused and a bundle of nerves.

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        • June 22, 2017 at 1:57 pm
        Janner
        Participant

          A 4mm margin standard for a 5x5mm biopsy?  I've never heard of a margin being based on a biopsy size.  It's always related to the lesion pathology itself, not biopsy size.  That margin size may be standard for their practice but it doesn't mean it is standard for everyone's practice.  5mm margins are typically indicated for severely atypical lesions and that is the only somewhat "standard" I know about for atypical lesions.  Mild and moderate – different doc, different standards.  I think you are fine with observation if you chose not to have the WLE.  Any pigment regrowth, just get it chopped out!

            • June 24, 2017 at 11:08 pm
            dhwriter
            Participant

              I may have misunderstood her, but it sounded rather clear that she was referring to the 4mm margin starting from the edge of the biopsy, as there were positive margins from the shave biopsy. How do they figure the lesion size if the lesion is gone, and the size of the mole was not documented by the dermatologist office? Do they guesstimate?

              Does 4mm margin sound right for a moderate atypia? I read so many different opinions by derms. From 2mm to 3 to 4.

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