What is an atypical mole?

Atypical nevi (moles) may look like melanoma (cancerous), but are in fact still benign. These moles may not be alarming to some individuals as they often look like a normal mole at a quick glance. Several factors have been defined to help identify atypical moles and these include:

  1. Asymmetry: Draw a line down the middle of your lesion, check if appearance of one half does not match the other. If the two sides do not match then they are asymmetrical, which is a warning sign for malignant transformation.
  2. Border Irregularity: Benign moles have smooth and even borders. If your mole has uneven, blurred, or jagged borders you should be checked by a medical professional to rule out an atypical mole or worse a melanoma.
  3. Color: Check the color of your lesion. Most benign moles tend to be a single shade of light brown. If the mole has an uneven, two tone color variation(termed variegated), or if it is very dark you may be at risk for melanoma.
  4. Diameter: Observe any change in size of your lesion, any mole larger than the size of a pencil eraser (about 6mm, or ΒΌ inch) should be evaluated by a medical professional.
  5. Evolution: It is important to check your current moles for change or evolution. If there is any change in shape, size, color, or any other trait such as the development of tenderness, itchiness, or bleeding (see symptomatic moles) make an appointment with your medical professional.

While atypical moles are not cancerous, any suspicious mole should be identified, monitored, and often treated in order to minimize the risk of transformation to a malignant melanoma such as a basal cell carcinoma or squamous cell carcinoma.

Treating Atypical Moles

Atypical nevi (moles) require a biopsy to determine degree of atypia. Atypical nevi are moles that have cellular and nuclear features that define their abnormality and likely transformation to a malignant melanoma. Degree of abnormality is characterized as minimal, moderate, and severe. Degree of abnormality defines amount of skin surrounding the mole that is required to be excised. Recommended excision parameters include:

Degree of atypia Recommended excision of normal skin surrounding the lesion
Minimal 1-2mm
Moderate 2-3 mm
Severe 3 to 5 mm

The recommended excision amount surrounding the mole(as above) doubled and added to the diameter of the mole determines the total excised diameter or the total size of the defect created following removal of the mole. The excision design follows the shape of a football or shape of the eye(termed bi-elliptical excision). Closure of this defect allows for closure in a straight line. The mole or tissue excised is then delivered to our private laboratory where the tissue is analyzed by a process termed permanent pathology analysis.

On occasion, the skin surrounding the defect is too tight to allow for a straight line closure; in such cases, a rearrangement flap closure is needed to repair the defect. Rearrangement flaps are created by making an assortment of back-cuts into the skin adjacent to the defect or hole created by the above excision. These back cuts allow Dr. Mowlavi to stretch and move skin from adjacent areas of looser skin to the hole that is lacking skin coverage. Your plastic surgeon, Dr. Mowlavi, will explain the various flap designs available and which design if necessary would best allow for closure of your defect.
Atypical nevus

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