Dr. Ata Moshiri highlights his lecture Atypical Nevi: A Dermatopathologist's Guide to Patient Conversations at the 2nd Annual Elevate-Derm Alliance Summer Conference in Park City, Utah at the Grand Hyatt Deer Valley.

In this video

In conversation with dermatology NP Veronica Richardson, Dr. Moshiri — Assistant Professor of Dermatology and Dermatopathology and Director of the Dermatopathology Fellowship at NYU Langone — makes the case that nomenclature matters. He explains that "dysplastic" dates to the 1970s and implies a pre-malignant, obligate precursor lesion, a framing an NIH consensus conference recommended abandoning more than 30 years ago. He prefers "atypical" to denote features that look unusual and overlap with early melanoma but don't necessarily mean the lesion is, or will become, melanoma; these are best thought of as markers of higher risk in patients who have many of them.

He addresses the well-documented inter-reader and intra-reader variability in grading mild, moderate, and severe atypia, and points to the MPATH scheme (proposed in 2014, revised in 2023) that sorts melanocytic growth into four classes — collapsing the troublesome "middle" into biologically meaningful low-grade and high-grade buckets that answer the real clinical question: "What am I doing with this mole?" He also predicts, "unequivocally yes," that AI will improve predictive models in dermatopathology within the next five to ten years, and offers guidance on managing moderately atypical path reports.

  • Prefer "atypical" over "dysplastic" — the older term wrongly implies an obligate pre-malignant precursor, a framing an NIH consensus conference recommended abandoning over 30 years ago.
  • Think of atypical nevi as risk markers: patients with many of them are at higher risk of melanoma, but the individual lesions themselves aren't necessarily dangerous.
  • Grading of mild/moderate/severe atypia has high inter-reader and intra-reader variability; the same slide may be called differently by different pathologists — or by the same pathologist months later.
  • The MPATH scheme collapses ambiguous grades into low-grade (leave alone) versus high-grade (cut it out); melanoma in situ falls in the high-grade class but has very high survivability.
  • For a moderately atypical report, look to the pathologist's recommendation first — remove lesions broadly involving margins or suggesting sampling error, but margin-free lesions with no recommendation can often be monitored clinically. When in doubt, call the pathologist.