› Forums › General Melanoma Community › Further Excision for Atypical Nevi
- This topic has 57 replies, 8 voices, and was last updated 8 years, 3 months ago by
grahamtosh.
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- November 26, 2013 at 5:33 pm
Hi,
I was diagnosed and treated for superficial melanoma on my chest in 2012. Doctor felt really good that it was all gone and have not had any reoccurrence in the area. Since then I've gotten regular checkups and had a few things taken off that all came back benign. During my most recent vist, I had two moles "punched" out on my abdomen. They came back atypical nevi. I don't know the severity. The doctor recommended given my melanoma diagnosis, that I should have these two areas treated with wider excisions. Is that necessary given that I already know they are atypical nevi and are now gone? I'm not sure how that could turn into melanoma if they are gone. I do have a lot of moles, am fair skinned and freckled. Any advice? Thanks.
- Replies
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- November 26, 2013 at 6:04 pm
This is something from what I’ve read from other people that really seems to be handled inconsistently among doctors. Since my mel diagnosis I’ve had lots of biopsies. Some have come back mildly atypical, and they don’t even go back and re-excise, even when the biopsy margins were involved. If it were moderately or severely atypical, they would. But I’ve read other people say their doctor goes go back and re-excise even mildly atypical. Odds are none of these things would have become melanoma, even if never biopsied to begin with. But, with our melanoma diagnoses, we are treated more cautiously and we get many biopsies of things that they’d probably leave alone on other people.
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- November 26, 2013 at 6:04 pm
This is something from what I’ve read from other people that really seems to be handled inconsistently among doctors. Since my mel diagnosis I’ve had lots of biopsies. Some have come back mildly atypical, and they don’t even go back and re-excise, even when the biopsy margins were involved. If it were moderately or severely atypical, they would. But I’ve read other people say their doctor goes go back and re-excise even mildly atypical. Odds are none of these things would have become melanoma, even if never biopsied to begin with. But, with our melanoma diagnoses, we are treated more cautiously and we get many biopsies of things that they’d probably leave alone on other people.
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- November 26, 2013 at 6:04 pm
This is something from what I’ve read from other people that really seems to be handled inconsistently among doctors. Since my mel diagnosis I’ve had lots of biopsies. Some have come back mildly atypical, and they don’t even go back and re-excise, even when the biopsy margins were involved. If it were moderately or severely atypical, they would. But I’ve read other people say their doctor goes go back and re-excise even mildly atypical. Odds are none of these things would have become melanoma, even if never biopsied to begin with. But, with our melanoma diagnoses, we are treated more cautiously and we get many biopsies of things that they’d probably leave alone on other people.
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- November 26, 2013 at 6:10 pm
There is no standard protocol for atypical nevi deemed mild or moderate but there is a recommendation for severely atypical nevi to have 5mm margins – just like melanoma in situ. Atypical nevi have a higher likelihood to turn into melanoma and if there are cells left behind, that is the worry. Were your margins clear? It may be ok to just watch the two scar areas and if there is any sign of pigment regrowth, you could have them excised then. I'd ask for copies of your pathology report (always a good idea) and discuss this more in depth with your doctor. In the end, because of the real lack of formal guidelines (other than severely atypical), this is all about what makes YOU feel comfortable.
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- November 26, 2013 at 6:10 pm
There is no standard protocol for atypical nevi deemed mild or moderate but there is a recommendation for severely atypical nevi to have 5mm margins – just like melanoma in situ. Atypical nevi have a higher likelihood to turn into melanoma and if there are cells left behind, that is the worry. Were your margins clear? It may be ok to just watch the two scar areas and if there is any sign of pigment regrowth, you could have them excised then. I'd ask for copies of your pathology report (always a good idea) and discuss this more in depth with your doctor. In the end, because of the real lack of formal guidelines (other than severely atypical), this is all about what makes YOU feel comfortable.
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- November 26, 2013 at 6:10 pm
There is no standard protocol for atypical nevi deemed mild or moderate but there is a recommendation for severely atypical nevi to have 5mm margins – just like melanoma in situ. Atypical nevi have a higher likelihood to turn into melanoma and if there are cells left behind, that is the worry. Were your margins clear? It may be ok to just watch the two scar areas and if there is any sign of pigment regrowth, you could have them excised then. I'd ask for copies of your pathology report (always a good idea) and discuss this more in depth with your doctor. In the end, because of the real lack of formal guidelines (other than severely atypical), this is all about what makes YOU feel comfortable.
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- November 26, 2013 at 6:39 pm
Janner is our resident expert on all things melanoma, especially nevi. I suggest that you follow her advice. Get a copy of your path report. Find out the severity of the atypia (mild, moderate or severe). Find out if the atypical cells extended to the margins of the biopsy specimen. Then think about your doctor's recommendation and how comfortable you are with getting wide excisions or just remaining vigilant about changes. There is no "right" or "wrong" answer here.
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- November 26, 2013 at 6:39 pm
Janner is our resident expert on all things melanoma, especially nevi. I suggest that you follow her advice. Get a copy of your path report. Find out the severity of the atypia (mild, moderate or severe). Find out if the atypical cells extended to the margins of the biopsy specimen. Then think about your doctor's recommendation and how comfortable you are with getting wide excisions or just remaining vigilant about changes. There is no "right" or "wrong" answer here.
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- November 26, 2013 at 6:39 pm
Janner is our resident expert on all things melanoma, especially nevi. I suggest that you follow her advice. Get a copy of your path report. Find out the severity of the atypia (mild, moderate or severe). Find out if the atypical cells extended to the margins of the biopsy specimen. Then think about your doctor's recommendation and how comfortable you are with getting wide excisions or just remaining vigilant about changes. There is no "right" or "wrong" answer here.
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- November 27, 2013 at 1:47 am
This was my experience. One year before I was diagnosed with stage IV melanoma, I had a mammogram that showed some sort of calcification they recognized as a potential problem. A biopsy was performed and the pathology came back "atypical" with no other indication, but could be a precancerous situation and should be watched. I was scheduled for mammograms every 3 months after that, but only completed one due to insurance coverage change. Exactly one year later, I was diagnosed with stage IV melanoma from a subcutaneous tumor that appeared on my rib cage. A PET scan revealed two more tumors in my breast, exactly where the biopsy was done one year previous. I'm not suggesting this is your situation but certainly once "atypical" shows up and you have a melanoma history, it is certainly reasonable why you would be concerned and should be watched closely! If it were me, knowing what I know now, I would go for wide excisions. I've had a lot of tumors removed (17) and just underwent a right axilla LND (lymph node dissection) 13 of the 25 lymph nodes were positive for melanoma and I've been in this battle for 4 years! Hope this helps!
Swanee
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- November 27, 2013 at 1:47 am
This was my experience. One year before I was diagnosed with stage IV melanoma, I had a mammogram that showed some sort of calcification they recognized as a potential problem. A biopsy was performed and the pathology came back "atypical" with no other indication, but could be a precancerous situation and should be watched. I was scheduled for mammograms every 3 months after that, but only completed one due to insurance coverage change. Exactly one year later, I was diagnosed with stage IV melanoma from a subcutaneous tumor that appeared on my rib cage. A PET scan revealed two more tumors in my breast, exactly where the biopsy was done one year previous. I'm not suggesting this is your situation but certainly once "atypical" shows up and you have a melanoma history, it is certainly reasonable why you would be concerned and should be watched closely! If it were me, knowing what I know now, I would go for wide excisions. I've had a lot of tumors removed (17) and just underwent a right axilla LND (lymph node dissection) 13 of the 25 lymph nodes were positive for melanoma and I've been in this battle for 4 years! Hope this helps!
Swanee
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- November 27, 2013 at 10:54 am
Some people just produce atypical nevi. If you went and had all of them biopsied, many might come back atypical, and would never have turned into melanoma. Get wide excisions on all of them and pretty soon you have no skin left. Make sure you trust the pathologist doing your pathology, and your doctor.
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- November 27, 2013 at 10:54 am
Some people just produce atypical nevi. If you went and had all of them biopsied, many might come back atypical, and would never have turned into melanoma. Get wide excisions on all of them and pretty soon you have no skin left. Make sure you trust the pathologist doing your pathology, and your doctor.
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- November 27, 2013 at 10:54 am
Some people just produce atypical nevi. If you went and had all of them biopsied, many might come back atypical, and would never have turned into melanoma. Get wide excisions on all of them and pretty soon you have no skin left. Make sure you trust the pathologist doing your pathology, and your doctor.
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- November 27, 2013 at 1:52 pm
Well, I'm not sure that I agree that "Some people just produce atypical nevi." As Janner said, there is a lot of confusion and controversy about the relationship between nevi and melanoma. However, indications are that people with many "common" nevi (i.e., >40) have a slightly increased risk of someday developing melanoma while people with many "dysplastic nevi" (i.e., >5) have a significantly greater risk of someday developing melanoma (see the review article from the National Cancer Institute at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234163/ ).
Note that this article does not say that any given dysplastic nevus will evolve into melanoma. What it says is that people whose genetic makeup tends to produce dysplastic nevi also tend to develop melanoma at rates greater than the general population.
Dysplastic nevi look different from common nevi so the chances of someone having dozens of needless biopsies of what turn out to be common nevi is slight. I do agree, however, that if someone has a hsitory of melanoma or a history of more than one dysplastic nevus, they should make sure that they start going regularly to a dermatologist with a lot of experience with melanoma. Dysplastic nevi (not common nevi) are a warning sign that you need to be vigilant.
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- November 27, 2013 at 1:52 pm
Well, I'm not sure that I agree that "Some people just produce atypical nevi." As Janner said, there is a lot of confusion and controversy about the relationship between nevi and melanoma. However, indications are that people with many "common" nevi (i.e., >40) have a slightly increased risk of someday developing melanoma while people with many "dysplastic nevi" (i.e., >5) have a significantly greater risk of someday developing melanoma (see the review article from the National Cancer Institute at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234163/ ).
Note that this article does not say that any given dysplastic nevus will evolve into melanoma. What it says is that people whose genetic makeup tends to produce dysplastic nevi also tend to develop melanoma at rates greater than the general population.
Dysplastic nevi look different from common nevi so the chances of someone having dozens of needless biopsies of what turn out to be common nevi is slight. I do agree, however, that if someone has a hsitory of melanoma or a history of more than one dysplastic nevus, they should make sure that they start going regularly to a dermatologist with a lot of experience with melanoma. Dysplastic nevi (not common nevi) are a warning sign that you need to be vigilant.
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- November 27, 2013 at 1:52 pm
Well, I'm not sure that I agree that "Some people just produce atypical nevi." As Janner said, there is a lot of confusion and controversy about the relationship between nevi and melanoma. However, indications are that people with many "common" nevi (i.e., >40) have a slightly increased risk of someday developing melanoma while people with many "dysplastic nevi" (i.e., >5) have a significantly greater risk of someday developing melanoma (see the review article from the National Cancer Institute at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234163/ ).
Note that this article does not say that any given dysplastic nevus will evolve into melanoma. What it says is that people whose genetic makeup tends to produce dysplastic nevi also tend to develop melanoma at rates greater than the general population.
Dysplastic nevi look different from common nevi so the chances of someone having dozens of needless biopsies of what turn out to be common nevi is slight. I do agree, however, that if someone has a hsitory of melanoma or a history of more than one dysplastic nevus, they should make sure that they start going regularly to a dermatologist with a lot of experience with melanoma. Dysplastic nevi (not common nevi) are a warning sign that you need to be vigilant.
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- November 27, 2013 at 2:36 pm
I don't want to quibble, but I can't let misinformation– especially frightening misinformation– go unchallenged. For information and photographs about how to distinguish common nevi from displastic nevi see the NCI publication: "Common Moles, Dysplastic Nevi, and Risk of Melanoma" at http://www.cancer.gov/cancertopics/factsheet/Risk/moles
Nothing in biology is 100% so maybe you are someone whose dysplastic nevi look the same as common nevi. But that is not the case for most people.
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- November 27, 2013 at 2:36 pm
I don't want to quibble, but I can't let misinformation– especially frightening misinformation– go unchallenged. For information and photographs about how to distinguish common nevi from displastic nevi see the NCI publication: "Common Moles, Dysplastic Nevi, and Risk of Melanoma" at http://www.cancer.gov/cancertopics/factsheet/Risk/moles
Nothing in biology is 100% so maybe you are someone whose dysplastic nevi look the same as common nevi. But that is not the case for most people.
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- November 27, 2013 at 2:36 pm
I don't want to quibble, but I can't let misinformation– especially frightening misinformation– go unchallenged. For information and photographs about how to distinguish common nevi from displastic nevi see the NCI publication: "Common Moles, Dysplastic Nevi, and Risk of Melanoma" at http://www.cancer.gov/cancertopics/factsheet/Risk/moles
Nothing in biology is 100% so maybe you are someone whose dysplastic nevi look the same as common nevi. But that is not the case for most people.
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- November 30, 2013 at 6:57 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:57 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:57 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- November 30, 2013 at 6:58 am
I've never had a needless biopsy. I'm the one in charge. My doc and I discuss everything and only biopsy things that change. That's our strategy and he doesn't call the shots, I do. I found my three primaries and expect to find any additional ones if that happens. I don't rely on any doc for just a visual opinion without proof of change. I rely on me knowing my body. I've never had a benign biopsy – either melanoma or dysplastic. Even changing moles don't have to be melanoma, but they are certainly high risk. Not all of my dysplastic nevi look "different" with a casual glance, but if you really look closely, I can see differences from "normal" and dysplastic.
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- January 24, 2016 at 9:40 am
Hi I had 2 melanomas removed last year and now and due to have 17 lesions that look like DN excised with margins . Not sure if this is overkill ? Anonymous above says ' make sure you trust your doctor and pathologist '. Do you mean I need to check if they are lying ? How the hell do I do that ? Thanks
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- January 24, 2016 at 9:40 am
Hi I had 2 melanomas removed last year and now and due to have 17 lesions that look like DN excised with margins . Not sure if this is overkill ? Anonymous above says ' make sure you trust your doctor and pathologist '. Do you mean I need to check if they are lying ? How the hell do I do that ? Thanks
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- January 24, 2016 at 9:40 am
Hi I had 2 melanomas removed last year and now and due to have 17 lesions that look like DN excised with margins . Not sure if this is overkill ? Anonymous above says ' make sure you trust your doctor and pathologist '. Do you mean I need to check if they are lying ? How the hell do I do that ? Thanks
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- November 27, 2013 at 1:47 am
This was my experience. One year before I was diagnosed with stage IV melanoma, I had a mammogram that showed some sort of calcification they recognized as a potential problem. A biopsy was performed and the pathology came back "atypical" with no other indication, but could be a precancerous situation and should be watched. I was scheduled for mammograms every 3 months after that, but only completed one due to insurance coverage change. Exactly one year later, I was diagnosed with stage IV melanoma from a subcutaneous tumor that appeared on my rib cage. A PET scan revealed two more tumors in my breast, exactly where the biopsy was done one year previous. I'm not suggesting this is your situation but certainly once "atypical" shows up and you have a melanoma history, it is certainly reasonable why you would be concerned and should be watched closely! If it were me, knowing what I know now, I would go for wide excisions. I've had a lot of tumors removed (17) and just underwent a right axilla LND (lymph node dissection) 13 of the 25 lymph nodes were positive for melanoma and I've been in this battle for 4 years! Hope this helps!
Swanee
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- November 29, 2013 at 2:23 pm
Since my diagnosis in August of 2012 I've had five additional biopsies. Two of the five were dysplastic nevi and were further excised. The scars are about 2 inches long, no biggie. To me, the moles all looked the same. I would not have guessed those two would be dysplastic. I am stage 3b and currently NED and see my Derm every 3 months. Personally, I will never hesitate to have a dysplastic further excised. The scars don't change me, just my skin.
Colleen
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- November 29, 2013 at 2:23 pm
Since my diagnosis in August of 2012 I've had five additional biopsies. Two of the five were dysplastic nevi and were further excised. The scars are about 2 inches long, no biggie. To me, the moles all looked the same. I would not have guessed those two would be dysplastic. I am stage 3b and currently NED and see my Derm every 3 months. Personally, I will never hesitate to have a dysplastic further excised. The scars don't change me, just my skin.
Colleen
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- November 29, 2013 at 2:23 pm
Since my diagnosis in August of 2012 I've had five additional biopsies. Two of the five were dysplastic nevi and were further excised. The scars are about 2 inches long, no biggie. To me, the moles all looked the same. I would not have guessed those two would be dysplastic. I am stage 3b and currently NED and see my Derm every 3 months. Personally, I will never hesitate to have a dysplastic further excised. The scars don't change me, just my skin.
Colleen
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- December 1, 2013 at 2:09 am
I'm with you Colleen. When it doubt I have it taken out and excised. It helps me sleep at night.
Holly
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- December 1, 2013 at 2:09 am
I'm with you Colleen. When it doubt I have it taken out and excised. It helps me sleep at night.
Holly
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- December 1, 2013 at 2:09 am
I'm with you Colleen. When it doubt I have it taken out and excised. It helps me sleep at night.
Holly
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- November 29, 2013 at 6:04 pm
what's the difference between "Clark's nevus" and "dysplastic nevus?"
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- November 30, 2013 at 4:57 pm
If Clark's is dysplastic, then either my pathologist is very liberal in using "Clark's" or almost every biopsy I've had in the last 2+ years has been dysplastic (almost all have said "Clark's"). Sometimes it's all excised with the biopsy, sometimes not. . but they still never recommend any further excision.
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- November 30, 2013 at 4:57 pm
If Clark's is dysplastic, then either my pathologist is very liberal in using "Clark's" or almost every biopsy I've had in the last 2+ years has been dysplastic (almost all have said "Clark's"). Sometimes it's all excised with the biopsy, sometimes not. . but they still never recommend any further excision.
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- November 30, 2013 at 4:57 pm
If Clark's is dysplastic, then either my pathologist is very liberal in using "Clark's" or almost every biopsy I've had in the last 2+ years has been dysplastic (almost all have said "Clark's"). Sometimes it's all excised with the biopsy, sometimes not. . but they still never recommend any further excision.
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Tagged: cutaneous melanoma
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