The Signs and Treatment for Atypical Melanocytic Lesions

Atypical melanocytic lesions, which are also called atypical moles or atypical melanocytic hyperlasias, are pigmented moles that contain abnormal cells. These moles are usually benign. However, in some cases, atypical melanocytic lesions can become melanomas. An exam or biopsy is used to determine the presence of these moles.

Characteristics of Atypical Melanocytic Lesions

A visual skin inspection is the primary way of finding lesions. There are five signs of a possible invasive melanoma in a mole, which are:

  • Asymmetrical sides
  • Blurred, irregular or uneven borders
  • Overly dark or different in color
  • Shape, size or color changes
  • Six millimeters or more in diameter

Biopsied and Diagnosed Atypical Melanocytic Lesions

After melanocytic lesions are found to be atypical, they are often surgically removed to stop the possibility of getting cancer. While this radical approach seems to be the best plan of attack, there is not enough evidence to support it. Excision decisions are based on the fourth classification level of these lesions, which is lentigomaligna, or melanoma-in-situ. The other three atypical melanocytic lesion classification levels are:

  • Mild atypia
  • Moderate atypia
  • Severe atypia

The Risk Rate Associated With a Melanoma-in-Situ

Since a melanoma-in-situ has a five percent risk of becoming malignant within 50 years, it is the only atypical melanocytic lesion level that warrants surgical removal. Logically, the other three lesion classification levels should carry a lower, and possible non-present, risk. To fully diagnose melanocytic lesions, a total excision is required.

Excision Considerations

The abnormality of these lesions can vary. For instance, a moderate atypia lesion may possess melanoma-in-situ in some areas, or a melanoma-in-situ may partially contain an invasive malignant melanoma. Variations can often be seen during a physical inspection.
Many surgeons are quick to remove mild, moderate and severe atypia lesions even if they are located on cosmetically undesirable areas. However, there is inadequate medical evidence to support this approach. In addition, a two millimeter to five millimeter margin is necessary to completely clear the lesion. Therefore, important points to consider are the:

  • Ability of identifying at-risk lesions with dermatography
  • Acceptability of observing the lesion
  • Deformity risks versus melanoma risks, especially for aging patients
  • Necessity of an excision and its margins
  • Reconstruction risks to the patient's general health

If you have a mole, we recommend having it examined immediately. Our team is readily available to assist you in this service.