Conservative Margins on Severe Atypia normal?

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!