Recurrent Atypical Nevus Following Multiple Excisions

Case at a Glance

A 24-year-old female presents with a recurrent atypical nevus that has regrown twice following surgical excision, despite wide local excision with margins. The lesion demonstrates morphological changes and has a concerning family history of melanoma.

Patient's Story

The patient first noticed an unusual mole during her teenage years. Due to its atypical appearance and her family history of melanoma, she sought dermatological evaluation. The lesion has been surgically removed twice - initially in 2019 and again in May of the current year. Despite excision with significant margins during the second procedure due to oncological concerns, the nevus has regrown with an altered morphology described as 'barbell-shaped'.

Initial Assessment

Physical examination revealed a pigmented lesion with atypical features including irregular borders and asymmetry. The patient's medical history is significant for a strong family history of melanoma. Previous surgical sites show evidence of recurrent pigmented tissue formation.

The Diagnostic Journey

Two separate excisional biopsies were performed with histopathological analysis. The first excision in 2019 was followed by rapid recurrence with continued morphological changes. A second, more aggressive excision was performed with wide margins due to clinical concern for malignant potential. Despite this approach, the lesion recurred with further morphological alterations.

Final Diagnosis

Recurrent atypical nevus with benign histopathology on two separate occasions. However, the persistent recurrence pattern and morphological changes warrant continued surveillance given the family history of melanoma.

Treatment Plan

Close dermatological monitoring with regular follow-up examinations. Consideration for dermatopathology consultation regarding the recurrence pattern. Patient education regarding warning signs and the importance of regular self-examination. Genetic counseling may be considered given the strong family history.

Outcome and Follow-up

Both histopathological examinations confirmed benign findings, providing reassurance. However, the unusual recurrence pattern requires ongoing vigilance. The patient has been counseled that while current pathology is reassuring, the recurrent nature and family history necessitate continued professional monitoring and prompt evaluation of any further changes.