Atypical Acral Naevus?

Hi, completely by chance I noticed a small (approx 3mm) mole on the sole of my foot early last month. I only have a small smattering of common moles and at 46 wouldn't expect any new ones (can't say for certain how long it's been there but my gut feeling is not long), especially in this location which I know is a danger area.

Phoned my GP right away and luckily got an appt for the following week. In the meantime I had a mole scan done at Boots. A bit like the Teledermy sevice. They contacted me to say the consultant who reviewed my mole said, under dermascopy, it was a benign looking naevus but due to it's recent development and location he recommended removal and biopsy under the 2 ww.

I was reassured by this and took a copy of the report to my GP who referred me and 16 days later I was seen in dermatology. This doctor said it felt raised, which surprised me as I thought it felt totally flat and under demascope he said it was atypical and suspicious and needed to be removed for biopsy.

I asked what he saw and he said it was a lace pattern with different colours including grey and globules indicating it was growing. I was really shocked and asked if it meant he thought it looked cancerous. He said that's not what he meant but without knowing the histology it could be benign in 6 months or it could be cancerous.

I received a copy of the GP letter a few days ago and the diagnosis says 'Atypical Acral Naevus' which is dusky grey, raised and lace patterned.

I guess my questions are, if he thought it had hallmarks of melanoma he would put that in the letter, I assume? The AAN diagnosis didn't have a question mark. He said in 6 months it could be benign... meaning it presently looks benign? He wasn't clear.

Does it sound as if the biopsy is to ensure it's removed to prevent any sinister change in the future as opposed to it currently looking sinister? Would melanoma still need to be ruled out? Dysplastic acral moles seem to have lots of variation due to the composition of skin in this area.

I also find it disconcerting that the first dermascopy said benign looking but in the clinic it had been upgraded to atypical. A big difference of opinion or a rapid change in three weeks?

I'm now awaiting a biopsy appt which could be up to four weeks. I'm so sad as I'd booked a dance weekend of all things for the end of June that I was SO looking forward to, and I'm clearly not going to be able to go now. Just seems so random. 

  • The process is completely different than before now. They had a roll out of a new fds scheme. Unfortunately I have not found that helpful to read up on. Meant to be 28 days from referral to diagnosis, Because I’m currently going through this process. And I hate to say it, but it’s a long one! Beginning of February I’ve been going through this whole process. 
    we’re now 3 months down the line, I’m waiting for my results and still none the wiser if I have skin cancer or not. 
    they placed me on the urgent pathway and whilst I was having my biopsy told me that I was under fast track. 
    7 weeks since surgery, I’ve still got no diagnosis. Whether that being benign or malignant. 
    The wait is very difficult. And I really hope the process goes much smoother for you. 
    wishing you the best and hope you get benign results

  • Very sorry to hear you've been waiting so long. Did you receive any kind of initial diagnosis?

  • No I haven’t unfortunately. 
    all I was told it’s suspected skin cancer from a new pigmented lesion. 
    nothing since, next week makes it 8 weeks since my biopsy so I’m really hoping I will have a diagnosis from then. But judging by how long this whole process is taking I’m really not sure 

  • Hi,

    It sounds to me like the consultant thinks there is more chance of it being atypical than benign. Atypical is also referred to as dysplastic or precancerous. This is when the cell structure they can see appears to be changing so they always remove an atypical mole. That's because it could turn completely malignant within a few weeks or it could take a few years - they prefer to remove it now whilst it's small (in depth) & easier to do. 

    Where the Boots dermascopy is concerned - it really is open to interpretation. You could get 2 NHS dermatologists examine it through a dermascope & they may slightly vary in their diagnosis. That is why it's always best to get it removed as only a biopsy can 100% confirm a diagnosis - the consultant's initial thoughts are really a 'pre-diagnosis.' Add into that the fact that atypical moles are also known as 'ugly ducklings' in the trade because they look suspicious but they haven't actually turned cancerous. Amongst all moles that have undergone a biopsy, the largest amount are atypical closely followed by benign & then melanoma. 

    I'm sorry you are still waiting for a surgical appointment. It appears that a 4 week wait is the average in the UK at the moment & the wait for the results is even longer. I suggest you contact them & say you are happy to take a last minute cancellation if one becomes available (if you can drop everything at a few hours notice). 

    I hope this helps & that you get an appointment through quickly. Please let us know how you get on,

    Angie (Stage 3 melanoma patient since 2009)

  • I'm sorry that you still haven't received your results after 7 weeks. It appears that 8 weeks is the current average wait for results in the UK with some hospital trusts taking even longer. This is sadly due to a lack of NHS histologists & a higher workload (more patients are seeing their GP about worrying moles/lesions). Have you contacted them to ask if your results are back yet? It may be that they are back but they haven't yet been discussed at the MDT (Multi Disciplinary Team meeting). All results, whether positive or negative, are discussed at the weekly meeting which consists of dermatology, plastics and oncology. This can sometimes hold up the results then being passed on to the patient.

    I hope you receive your results through soon & they bring good news. Good luck and please let us know how you get on (if benign, it helps others going through the same to know that not all moles are melanoma).

    Angie Tough (Stage 3 melanoma patient since 2009).

  • Ah, thank you for your explanation Angie. It has helped me understand a bit better. Basically what I'm dealing with currently is something that has the potential to turn nasty at some point in the future? And that the dermatologists very much err on the side of caution in removal to catch anything before it could turn? 

    And as coincidence would have it, I literally got a call from the clinic a little earlier for an appt on 2nd June, so a little over a 5 week wait. I will do as you suggest regrading cancellations and give them a call back to get put on their list. The quicker this little creepy weirdo is gone, the happier I'll be.

  • Yes, you are correct in your assumption.

    I'm glad you have least got an appointment through. Hopefully you will get a cancellation through to get it done earlier. I've managed to get it done quicker twice that way. Good luck.

  • Fingers crossed! Gave them a ring and they said they do get quite a number of cancellations but it's the urgent referral patients that take them but I'm welcome to ring daily to check. I quickly I added that I was one of the urgents and she happily took my number and said she'd call me.

    Seemed to indicate there was just one other patient at the moment who was looking for cancellations, so here's hoping I'm second in queue.

  • That's good to hear. Fingers crossed for you x

  • Thought I'd try my luck last Friday and gave them a quick ring. The same lady who had been optimistic regarding cancellations seemed less so when I said it was a biopsy. I guess they get far more cancellations for routine apps than they do biopsies. She still said she'd give me a call if anything came up so my fingers are still crossed.

    I think I'm just getting more anxious to get rid of this little creeper. I actually thought it hadn't grown so found it a bit disconcerting to compare it to a photo from a month ago. It has clearly grown about 2mm!!

    I guess I shouldn't be alarmed as the derm said I was growing, but I'm just so suspicious of the area it's in.