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Clear margins but atypical mole comes back, why?

Forums Cutaneous Melanoma Community Clear margins but atypical mole comes back, why?

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      3 years ago I had several moles biopsied, 2 of which came back “moderate atypia”. Since the pathology report stated that the margins were clear for both, my dermatologist said that no further treatment was necessary. However, after a few weeks one of the atypical moles was coming back at the biopsy site. Can someone please explain to me, how is that possible with the clear margins? Doesn’t “clear margins” mean that all mole cells were removed?

      Follow up story. I went back to the dermatologist who did a WLE with 5mm margins. I wanted a WLE on the other atypical mole too but the dermatologist said “there is nothing to excise, if it starts coming back, come see us and we will take care of it”. To date, none of these 2 moles came back, thankfully. But I am still baffled by how can the mole come back if the path report stated “clear margins”. Also was it the right decision to leave the other atypical mole biopsy site alone, or maybe I should have pressed harder to have it WLE’d as well?

      Thanks so much for your responses!

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          Hey Ellie,

          It is hard to say for sure why your mole came back. However, the most likely reason is that there was a microscopic cell in the margins that was missed, therefore rendering them not as “clear” as was thought. It is also possible that a different mole just happened to come up in that location, though I think the prior scenario is most likely.

          I think what your derm recommended in the end is perfectly fine….ie no need for WLE of the removed lesions that did not return at this time. Hopefully, the biopsy results you are waiting for will be simply an atypical mole as well and if that is the case, hopefully you are done with all of this. Yours, c

              Hi Celeste, thanks again for your reply! Those atypical moles I asked for were removed 3 years ago (I was pregnant at the time and noticed them getting a bit darker), I guess now with the stress of a new biopsy it resurfaced in my mind. As regarding the current biopsy, I noticed a new slightly raised pigmented spot on my back, about 3mm in diameter. I am certain that it was new as I had full body pictures done and it wasn’t there. Ironically, I am also pregnant right now too. The spot looked benign and blended in quite well with the other sun spots on my back, but it being new and raised freaked me out. The dermatologist said “I don’t think that it’s anything worrisome” but he shaved it off anyway. I am hoping it is something completely benign, like seborrheic keratosis. But if it is any kind of atypia, I wouldn’t want any pigment coming back there. Of course, I am hoping that it isn’t melanoma. But if it is, with it being small, round, and a uniform medium brown color, I am at least hoping that it is very early and curable. Thanks again for your support and responses!
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