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Old 11-17-2011, 02:23 PM   #1
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Is a punch biopsy good to take out a mildly atypical mole?

I had a few shave biopsies done to take out a few moles. Two came back as mildly atypical. These are my first. So the PA said they would do a punch biopsy next time to take the surrounding area/left over cells out. I told her I wanted to do an excision but she said it was not necessary. I don't see any visible mole left but obviously there are cells left. I asked online on this site where doctors reply to your question. A plastic surgeon said that I absolutely need to have a plastic surgeon to do a full excision and telling me how the PA could not be more wrong and doing a shave and punch will mess up the diagnosing of melanoma. There was no melanoma found first of all and it was mildly atypical. I've already done the shaves so can't do anything about that so I'm just wondering if a punch biopsy is good enough of a precautionary measure to make sure these moles don't come back or turn into something bad. Should I push for an excision or should a punch biopsy be enough to take out the surrounding area for clear margins?

Also how likely is it that the pathologist made a mistake in the diagnosing? I mean the difference between melanoma and mildly atypical is big. If it was severely atypical to melanoma I understand. I mean you have to be a really bad path to make a huge mistake like that right? I'm just nervous.

Thank you for your responses!

Last edited by hkwak002; 11-18-2011 at 08:18 AM.

 
Old 11-20-2011, 11:23 AM   #2
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Chele60 HB UserChele60 HB UserChele60 HB UserChele60 HB UserChele60 HB UserChele60 HB User
Re: Is a punch biopsy good to take out a mildly atypical mole?

Hello and welcome!

Okay, this is just my own personal thing, but I don't know that I would be taking the word of a doctor over the internet who has never seen me or really doesn't know my condition. On this board, I tell people straight up I am not a medical professional, and what I know I know from my own experience and research. I also tell people if they are truly worried about something, they need to see (as in person) their own doctor - or find a doctor they feel comfortable with. Over the internet, we can all be who we want to be, we don't really have to give anyone any sort of credentials.

That said, you state you have mildly atypical moles. Are you even aware of what that means? And are you aware of how that relates to melanoma? Atypical moles may or may not eventually, possibly, at some time, in the future, way, way distant develop into melanoma. Could. Possibly. Maybe. And the stars could align just right and I, at the age of 51, could become Miss Universe. Detect a bit of sarcasm there?

There are 2 schools of thought as far as doctors are concerned. One school says, either leave the atypical mole alone, or do a shave/punch biopsy, and simply keep an eye on it and see if anything develops. The majority of the time? Nothing happens. The other school says, take full on preventative measure: do a complete wide excision in the event that melanoma may ever develop, and we will all be ahead of the game by taking out all of skin before it ever has a remote chance of ever taking hold.

What YOU need to think of - because, this is YOUR body that is being discussed - is there could be more atypical moles develop as you get older. A shave/punch removal is not all that bad in terms of having them removed. If you have an excision? Much more devastating to your body. You will have large chunks of skin removed. Now, granted, I'm sure a plastic surgeon would love to get a patient like that. Think about it, it isn't hard. A simple mole removal via punch really doesn't cost all that much. An excision? With perhaps local or general anesthia? With perhaps some level of reconstruction, depending on where the mole is located? Perhaps I'm cynical, but I'm seeing more dollar signs than patient care. Why would doctor necessarily care if s/he is carving up a patient (and scaring them to death) and receiving payments from insurance?

Hey, it's your body, it's your peace of mind. If you would feel better getting an excision for every atypical mole a doctor finds, you will certainly find a plastic surgeon willing to accommodate your wishes. Just allow yourself time to think and research about what you are doing, and have an open and honest conversation with your doctor.

Good luck!

 
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Old 11-20-2011, 04:57 PM   #3
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Re: Is a punch biopsy good to take out a mildly atypical mole?

Hi Chele60,

Thank you for your reply. So basically, I'm kind of blowing this thing out of proportion? I know what atypical moles are and how they are related to melanoma. From my research I know that having just one atypical mole increases my risk of melanoma in the future. I just have this fear that the pathologist (wasn't a dermapathologist) may not have done a good job looking at the mole and may have misdiagnosed it. I mean I'm sure under the microscope the difference between a mildly atypical mole and melanoma has to be big so to miss that has to be rare right? I'm just an overall paranoid person. My PA suggested a punch biopsy but I'm the one that pushed for an excision. I don't think it will be a full excision a bit smaller.

Also another thing is I just got a copy of my pathology report and the wording confuses me. My PA told me I just had two moles with mild atypia but on the report it says "lentiginous junctional nevus with mild atypical melanocytic hyperplasia extending to margins." I don't know if you would be able to decipher that but from my research I found that "atypical melanocytic hyperplasia" could possibly mean melanoma in-situ. I will ask my PA later but I'm just wondering if it is actually melanoma in-situ or just a mildly atypical mole. I don't think they would say its just atypical if in fact it is an in-situ. I mean since an in-situ is still melanoma there are cancerous cells and to say that its atypical just because its only on the surface would not be right.

Thank you for your input!

Last edited by hkwak002; 11-20-2011 at 05:02 PM.

 
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