Biopsy diagnosis

Posted By
9/13/2018 4:42pm
Replies: 6

Hi there, 

I had my first mole check, which led to a biopsy and now I will be going in for another procedure (I believe a WLE). I have a question about my biopsy results, final diagnosis: severely atypical junctions melanocytic proliferation, which I know is not yet melanoma. There is a statement in the report that says it is “concerning for early evolving melanoma in situ, lentigo maligna type”. Does that statement change this to an in situ? Maybe it was so close they weren’t sure which to call it? I realize I’m very lucky with either situation and many here are facing more complicated diagnoses. I am trying not to worry too much, and so I’m staying away from he Internet (other than this forum) to find some answers. How concerning is this diagnosis? I’m thinking this one procedure and regular mole checks should be adequate after this? I am wondering if, even with clear margins after my WLE, is it possible for it to not be completely removed from my arm? Also, I’m wondering why a Mohs surgery is not the preferred treatment, is a WLE as effective? Thanks for your insight on this, I appreciate it. 

mandyjill - (9/13/2018 - 5:39pm)

I'm a little surprised they are doing a WLE if it's not melanoma.  That's generally what they do after it's deternined to be melanoma.  And yes it's very effective.

Janner - (9/13/2018 - 8:13pm)

WLEs are done on severely atypical lesions with the same margins as melanoma in situ.  There is not a definite line between atypical features - it's a continuum.  So if your final diagnosis is severely atypical, they think that there isn't enough atypical features to call this "cancer" at this point.  But the characteristics point to the scenario that this lesion likely would have continued to grow and eventually end up as cancer - hence the "evolving" terminology.

Mohs surgery is not typically used for melanoma.  Mohs uses frozen section technique to provide quick turn around to see if cancer cells are in the removed tissue.  Melanocytes don't show up well in frozen sections.  Melanocytes are best viewed when they can be stained and processed in paraffin.  This is why the WLE is typically done for melanoma.  Basal cells and squamous cells do show up well on frozen sections which is why that technique is often used for BCC and SCC. 

amlye - (9/14/2018 - 10:15pm)

Thanks for the replies. That makes more sense to me now on the procedure choice. Does it really even matter if it’s severely atypical vs. in situ? They are both treated the same it seems, but I’m wondering if there’s a difference in prognosis? Thanks again! 

Amber Seely 

Janner - (9/15/2018 - 10:40am)

Prognosis?  One isn't considered cancer.  It's a better prognosis.  It may never have changed to melanoma in situ.  Melanoma in situ is cancer confined to the epidermis only.  In theory, melanoma in situ lacks the ability to spread because there are no lymph or blood vessels in the epidermis.  If they had the same prognosis, then they would include severely atypical lesions as stage 0.  They don't.  Most docs do the 5mm WLE for severely atypical to err on the side of caution.  I would prefer that diagnosis over in situ.

amlye - (9/16/2018 - 12:30am)

Thank you for your insight and for taking the time to reply.  

Amber Seely 

Anonymous - (10/7/2018 - 10:14pm)

I received clear margins after my WLE! My dermatologist informed me that when they called him with results on my biopsy, they went back and forth on whether or not they should call my mole an in situ. He said it was 100% going to be one if it wasn’t already. Glad I caught it early, feeling very thankful.