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“Moles are really a spectrum,” says Dr. Adam Mamelak, board-certified dermatologist in Austin, Texas. At one end of the spectrum are regular benign moles, at the other end is skin cancer. Then, there’s everything in between!”
Regular dark moles or beauty marks are typically classified as junctional, compound, or dermal, depending on where the mole or nevus cells are located within the skin. Moles are known as atypical if their cells or distribution change in an abnormal way within the skin.
“Really, this is something we evaluate under the microscope,” says Dr. Miriam Hanson, board-certified dermatologist in Austin, Texas. If a mole appears as atypical or suspicious on the skin, a skin biopsy is performed. That skin specimen is then examined by a pathologist under the microscope for abnormal features. The pathologist reports specific abnormal features that they observe in the biopsy.
For example, if the nevus cells do you not stay in their nests and start to spread out in a linear fashion along the junction between the epidermis and dermis of the skin, this is referred to as “lentiginous spread.”
When the nests of nevus cells start to make bridges with one another, this is referred to as “architectural disorder.”
Finally, if the Nevis cells themselves start to appear larger, in an atypical shape or have an abnormal appearance, this is referred to as “atypia.”
“Atypia is often graded as mild, moderate, or severe,” says Dr. Mamelak. It is the moderate and severely atypical nevi that fall closest to melanoma skin cancer on the spectrum. Often, these are the ones where further treatment might be recommended.