ZocdocAnswersCan pathologist spot differences (microscopically) between dysplastic and melanoma?

Question

Can pathologist spot differences (microscopically) between dysplastic and melanoma?

I plan on seeing derm tomorrow but I have many questions. If the derm thinks that a mole may be melanoma but it's sent to a lab and confirmed benign, how do they do that just by looking under a microscope? Is there a structural cell difference between dysplastic vs. carcinoma? I have a black mole on my back, 6mm all around, slightly irregular and has been there for a long time, 2-3+ years. (Not sure how long) I am scared, very scared. I have already taken an inventory of 90 percent of my moles and freckles. But I'm gonna ask my derm to do it professionally though. Is there ever occurrences where a pathologist may say its benign but really not? Do dysplastic nevi have a different color, shape than melanoma cells when looked under a microscope?

Answer

The answer to your question is yes, the pathologic evaluation of your mole can determine whether it is melanoma, a dysplastic nevus, or some other type of mole. There are structural cell differences that can be differentiated under a microscope and with special stains. In addition, normal tissue around the mole can be examined to see if it contains any concerning features. Most of the time the pathologic diagnosis is definite, while other times the pathologist may not be entirely sure what the problem is. While certainly there is the potential for human error, most of the time they get it right. If there is a question of whether or not the lesion is malignant, then the pathologist will note this in the pathology report and your dermatologist will act accordingly. It sounds like you have a lot of moles and thus will probably need further follow-up in the future. I would suggest that you continue to follow up with your dermatologist regularly for skin checks to make sure that none of these moles are becoming concerning. In addition, you should periodically check your moles that you can see in your body to see if they are changing in any way. These are the things that you can do yourself to ensure that nothing gets missed. Again, please speak with your dermatologist.

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