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Suggest Treatment For Dysplastic Nevi
Question: Hi Dr. Kakkar...you will probably not be surprised to see it's me again! (You'll be able to feature me in a chapter of your book, should you ever decide to write one, under "hypochondriac patients"!
I have a totally different question....one week ago my dermatologist removed three pigmented lesions, one from my inner forearm and two on my abdomen (I'm attaching images post removal). I had the lesions for years and they never had changed, I actually asked her to remove them for cosmetic reasons (and so that I wouldn't have to neurotically monitor them!). As you will notice from the images, she did a scrape biopsy of each and thereafter used electrocautery.
I just received a message from their office with the biopsy results, showing that all three came back as mildly dysplastic nevi (as a matter of fact, I had two similar lesions removed in the same fashion last year, they looked very similar, but the biopsies came back as normal nevi).
My doctors office indicated that no further treatment is needed. Can you just explain to me a bit about what "mildly dysplastic" means, and do you agree that no further treatment is warranted? Obviously I will continue to go for yearly skin screenings and watch those areas myself, but do I have to be overly obsessed with those areas (it looks like they were fully removed?)?
Thank you again for always being there for me and for being so kind and compassionate!!!!
I have a totally different question....one week ago my dermatologist removed three pigmented lesions, one from my inner forearm and two on my abdomen (I'm attaching images post removal). I had the lesions for years and they never had changed, I actually asked her to remove them for cosmetic reasons (and so that I wouldn't have to neurotically monitor them!). As you will notice from the images, she did a scrape biopsy of each and thereafter used electrocautery.
I just received a message from their office with the biopsy results, showing that all three came back as mildly dysplastic nevi (as a matter of fact, I had two similar lesions removed in the same fashion last year, they looked very similar, but the biopsies came back as normal nevi).
My doctors office indicated that no further treatment is needed. Can you just explain to me a bit about what "mildly dysplastic" means, and do you agree that no further treatment is warranted? Obviously I will continue to go for yearly skin screenings and watch those areas myself, but do I have to be overly obsessed with those areas (it looks like they were fully removed?)?
Thank you again for always being there for me and for being so kind and compassionate!!!!
Brief Answer:
Regarding dysplastic nevi
Detailed Answer:
Hello XXXXXXX Thank you for your direct query to me.
I am more than happy to answer all your questions, the best I can.
Dysplastic nevi are atypical nevi which may have shades of brown or XXXXXXX are larger than most typical nevi, irregular, ill defined and may have a central raised component. These clinical features are somewhat similar to an early melanoma and dysplastic nevi may in fact resemble an early melanoma clinically but unlike melanoma the atypical cells in a dysplastic nevi are confined to the epidermis and there is no involvement/invasion of the dermis on histopathology (this is important because only involvement of the dermis imparts malignant potential). Therefore complete removal of dysplastic (i.e with free biopsy margins and with no involvement of dermis) is curative. A mildly dysplastic nevi means that it did nt look grossly abnormal clinically in terms of size, shape, margins and color variation and had only a few slightly atypical cells on histopathology.
Regards
Regarding dysplastic nevi
Detailed Answer:
Hello XXXXXXX Thank you for your direct query to me.
I am more than happy to answer all your questions, the best I can.
Dysplastic nevi are atypical nevi which may have shades of brown or XXXXXXX are larger than most typical nevi, irregular, ill defined and may have a central raised component. These clinical features are somewhat similar to an early melanoma and dysplastic nevi may in fact resemble an early melanoma clinically but unlike melanoma the atypical cells in a dysplastic nevi are confined to the epidermis and there is no involvement/invasion of the dermis on histopathology (this is important because only involvement of the dermis imparts malignant potential). Therefore complete removal of dysplastic (i.e with free biopsy margins and with no involvement of dermis) is curative. A mildly dysplastic nevi means that it did nt look grossly abnormal clinically in terms of size, shape, margins and color variation and had only a few slightly atypical cells on histopathology.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
hellnagain and many thanks again Dr. Kakkar!! Now I'm concerned as i read that having dysplastic nevi puts you at greater risk of melanoma. I go for yearly skin exams with a dermatologist and am vigilant about checking my skin. Is there a great deal for me to be concerned about? I had two other moles removed last year and biopsies showed both were normal. The only other larger moles which I had (in addition to the above five) were about six others on my back, which my primary care doctor removed by electrodessication and curettage 17 years ago (no biopsies were done). Those were the total of the eleven larger moles I had since I was 17 years old (I'm 50 now); any other pigmented lesions I have are smaller moles and or freckles. I just had a skin exam completed and everything was fine. Unfortunately I turned to google and ran across FAMMM, which I understand is a family genetic predisposition to melanoma, and now I am very concerned about that. My father died 11 years ago from cardiac arrest, but I remember seeing that he had a lot of strange looking pigmented lesions on his back, one on his arm and one on his leg; of course he never went to a dermatologist to be checked, and I'm hoping that perhaps they were just seborrheic keratosis, as they seemed to have that stuck in appearance. Also, I remember seeing them in him for a period of about twenty years, so I presume if it was melanoma he certainly wouldn't have lasted that long. Do you think I have anything to worry about in relation to that FAMMM? (My googlingnof medical conditions will kill me from anxiety before anything else!). Thank you!
Brief Answer:
You don't have a familial melanoma syndrome
Detailed Answer:
Hi.
I don't think you have FMMM (Familial Atypical Multiple Mole and Melanoma Syndrome).
For a patient to be diagnosed as FMMM syndrome, he/ she needs to satisfy all the following three criteria -
1. Malignant melanoma in one or more first- or second-degree relatives. Patients usually have a history of either multiple primary invasive melanomas or a family history of malignant melanomas in first or second degree relatives.
2. High total body nevi count (often >50) including some of which are clinically atypical (asymmetric, raised, color variegation present, of variable sizes)
3. Nevi with atypical histologic features on microscopy/ histopathology.
Neither you nor anyone in your family has a history of Melanomas so I don't think you need to worry about FMMM.
Most of the patients with FMMM syndrome also have genetic mutation in CDKN2A gene. This screening is offered to patients suspected of FMMM syndrome i.e either personal history of multiple melanomas and/ or history of melanomas in family members.
You may continue with your yearly routine yearly skin exams.
Regards
You don't have a familial melanoma syndrome
Detailed Answer:
Hi.
I don't think you have FMMM (Familial Atypical Multiple Mole and Melanoma Syndrome).
For a patient to be diagnosed as FMMM syndrome, he/ she needs to satisfy all the following three criteria -
1. Malignant melanoma in one or more first- or second-degree relatives. Patients usually have a history of either multiple primary invasive melanomas or a family history of malignant melanomas in first or second degree relatives.
2. High total body nevi count (often >50) including some of which are clinically atypical (asymmetric, raised, color variegation present, of variable sizes)
3. Nevi with atypical histologic features on microscopy/ histopathology.
Neither you nor anyone in your family has a history of Melanomas so I don't think you need to worry about FMMM.
Most of the patients with FMMM syndrome also have genetic mutation in CDKN2A gene. This screening is offered to patients suspected of FMMM syndrome i.e either personal history of multiple melanomas and/ or history of melanomas in family members.
You may continue with your yearly routine yearly skin exams.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. Kakkar once again I cannot begin to thank you enough for your support and reassurances!
One last, more basic question: of the three moles which I just had biopsies, two came back as mild/moderate dysplasia and one as mild dysplasia. I had had two other moles removed (all were done by shave) a few months ago which looked extremely similar to those three just removed, and those two biopsy reports were normal. I had all five of those moles probably since being a teenager and none had changed at all.
My dermatologist said no further treatment is needed, just to continue with yearly screenings.
Is it a relatively common thing for a person to have mild or mild/moderate atypical moles?
Thank you again for being there for me so much:)
One last, more basic question: of the three moles which I just had biopsies, two came back as mild/moderate dysplasia and one as mild dysplasia. I had had two other moles removed (all were done by shave) a few months ago which looked extremely similar to those three just removed, and those two biopsy reports were normal. I had all five of those moles probably since being a teenager and none had changed at all.
My dermatologist said no further treatment is needed, just to continue with yearly screenings.
Is it a relatively common thing for a person to have mild or mild/moderate atypical moles?
Thank you again for being there for me so much:)
Brief Answer:
Continue with yearly screening
Detailed Answer:
Hello.
It is quite a common thing to have 2-3 mildly dysplastic nevi in normal individuals. Most dysplastic nevi never turn into an invasive melanoma. It is also not necessary to remove all the moles because majority of melanomas dont arise from pre-existing moles. Only clinically atypical nevi (dysplastic nevi) should be removed and the other moles can be monitored for any morphological changes.
Regards
Continue with yearly screening
Detailed Answer:
Hello.
It is quite a common thing to have 2-3 mildly dysplastic nevi in normal individuals. Most dysplastic nevi never turn into an invasive melanoma. It is also not necessary to remove all the moles because majority of melanomas dont arise from pre-existing moles. Only clinically atypical nevi (dysplastic nevi) should be removed and the other moles can be monitored for any morphological changes.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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