Cellular Health and Dysplastic Nevi in Depth

Cellular Health and Dysplastic Nevi: Wellness Guide

Abstract

This educational post explores the clinical management of a dysplastic nevus, or atypical mole, from an integrative perspective. We begin by walking through the procedural steps of a re-excision following a shave biopsy that revealed moderate atypia. This involves meticulously planning the excision, administering a pain-free field block with lidocaine and epinephrine, and preparing the site for removal. Beyond the procedure itself, we’ll explore the deeper physiological implications. For example, we’ll discuss why a dysplastic nevus is more than just a “skin issue”—it’s a potential indicator of underlying systemic processes. These include chronic inflammation, oxidative stress, and impaired cellular detoxification.

We will explore how functional medicine principles allow us to investigate these root causes. This post also highlights our clinic’s collaborative, multidisciplinary approach. My chiropractic and functional medicine work is integrated with the medical oversight of our Medical Director, Dr. Maria Guadalupe Cardenas, MD. Moreover, we will explain how this team-based model, incorporating chiropractic adjustments, rehabilitation, and nutritional strategies, provides a comprehensive framework. This model addresses the local lesion while optimizing overall systemic health and reducing the risk of future cellular dysfunction.

Our Integrative and Collaborative Clinical Model

At Injury Medical Clinic PA, our philosophy is rooted in a comprehensive, patient-centered approach. We have structured our practice as a multidisciplinary team to ensure that every patient benefits from a wide spectrum of clinical expertise. I am Dr. Alex Jimenez, and my credentials span chiropractic (DC), advanced practice nursing (APRN, FNP-BC), and certified functional medicine (CFMP, IFMCP). This allows me to view health through multiple lenses, from biomechanical integrity to cellular and metabolic function.

A cornerstone of our practice is my collaboration with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is Board Certified in Internal Medicine and serves as our esteemed Medical Director and Collaborative Physician. With over four decades of experience as an internist, she provides invaluable medical oversight and diagnostic acumen. This MD-DC collaboration is fundamental to integrative care. It allows us to seamlessly blend conventional medical diagnostics and treatments with chiropractic, functional medicine, rehabilitation, and personal injury care. As a result, we ensure that our treatment plans are not only effective but also safe, evidence-based, and holistically aligned with each patient’s unique health journey.

Managing a Dysplastic Nevus: A Procedural Walkthrough

Initial Assessment and Planning the Excision

This morning, I cared for a 62-year-old patient. About a month ago, we performed a shave biopsy on a skin lesion. Histopathological examination identified it as a dysplastic nevus with moderate atypia. A dysplastic nevus is an atypical mole in which the cells show some degree of abnormal development. The term “moderate atypia” means the cellular changes are more pronounced than mild atypia. This places it on a risk spectrum that warrants careful management. The primary goal is to prevent its potential progression to malignant melanoma.

Therefore, today’s procedure is a re-excision. The standard of care for a nevus with this level of atypia is to remove it completely with a clear margin of healthy tissue around it. This ensures that any atypical cells that may have extended beyond the visible border of the original lesion are also removed, significantly reducing the risk of recurrence or malignant transformation (Gawkrodger, 2012).

• Preparing the Area: The first step is always meticulous preparation. I prepped the patient’s skin with alcohol to ensure an aseptic field.
• Mapping the Excision: For precision, I use a sterile surgical template. The original lesion measured approximately five by six millimeters. The protocol requires a narrow but definitive margin, so I planned for about a two-millimeter margin around the scar from the initial biopsy, which equates to roughly a five-millimeter margin around the footprint of the original lesion. I carefully marked this elliptical shape on the skin to guide the incision and facilitate a clean, linear closure.

The Art and Science of a Pain-Free Field Block

Administering Anesthesia with Precision and Comfort

A primary concern for any minor surgical procedure is patient comfort. My goal is to create a completely numb surgical field before the first incision is ever made. To achieve this, I use a field block technique, which I find exceptionally effective. A field block creates a “fence” around the surgical site, blocking nerve signals before they reach the brain.

• The “Anesthetic Fence”: I began by selecting an entry point just outside my marked excision area. I injected a solution of 1% lidocaine with epinephrine.
  • Lidocaine is a local anesthetic that blocks sodium channels in nerve fibers. When these channels are blocked, nerves cannot generate an action potential, and pain sensation is completely interrupted.
  • Epinephrine is a vasoconstrictor. Its inclusion is crucial for two reasons: First, it constricts the local blood vessels, which reduces bleeding during the procedure. Second, and just as importantly, it slows the absorption of lidocaine into the bloodstream. This keeps the anesthetic concentrated in the target tissue longer, prolonging its effect and allowing me to complete the procedure without re-injection (Becker & Reed, 2006).
• The Injection Technique: I advanced the needle into the subcutaneous tissue and injected the solution as I withdrew it. Before fully removing the needle, I redirected it to anesthetize the adjacent area, creating one side of the “fence.” I repeated this procedure on the opposite side. This method is efficient and minimizes skin punctures.
• Ensuring a Painless Needle Stick: To make the initial injection completely painless, I use a vapocoolant spray on the skin right before the needle stick. The intense cold provides instantaneous, transient numbness. When I asked the patient if he felt anything, he confirmed he did not. This small step makes a significant difference in the patient experience.

Achieving Deep Numbness with Intradermal Injection

Once the deeper subcutaneous tissue was anesthetized, the next step was to ensure the dermis—the layer of skin I would be incising—was also completely numb.

• Subdermal Saturation: With the deeper nerves now blocked, I could proceed with the intradermal injections without causing the patient any discomfort. I threaded a long, thin needle just underneath the skin, within the dermis. You can visibly see the needle tip through the skin, which allows for extreme precision.
• Creating a “Wheal”: I injected the anesthetic as I withdrew the needle, creating a raised, blanched line or “wheal.” This visible distension of the skin clearly shows that the intradermal layer is saturated with anesthetic. I performed this on all four sides of my marked ellipse. During this time, I checked in with the patient, and he said he felt no pain.

By the end of this meticulous process, we had achieved a perfectly anesthetized field, ready for the excision. This careful, layered approach to anesthesia is fundamental to a positive and pain-free patient outcome.

The Functional Medicine Perspective: Why a Mole Isn’t Just Skin Deep

While the surgical excision addresses the immediate physical lesion, my training in functional and integrative medicine compels me to ask a deeper question: Why did these atypical cells develop in the first place? From a functional medicine standpoint, a dysplastic nevus is not just a localized skin problem; it may reflect an underlying systemic imbalance. It represents a focal point where the body’s normal cellular regulation has faltered.

Chronic Inflammation and Oxidative Stress

Atypical cell development often occurs downstream of two core physiological processes: chronic inflammation and oxidative stress.

• Chronic Inflammation: Unlike acute inflammation, which is a healthy and necessary response to injury or infection, chronic low-grade inflammation creates a cellular environment ripe for dysfunction. Inflammatory cytokines can promote cell proliferation and inhibit apoptosis (programmed cell death), two of the classic hallmarks of cancer development (Coussens & Werb, 2002). Diet (e.g., high intake of processed foods, sugar, and unhealthy fats), chronic infections, gut dysbiosis, or exposure to environmental toxins can drive this pro-inflammatory state.
• Oxidative Stress: This occurs when an imbalance between the production of reactive oxygen species (ROS), or free radicals, and the body’s ability to neutralize them with antioxidants occurs. ROS can damage DNA, proteins, and lipids, leading to mutations that can trigger the development of atypical cells. Our antioxidant defenses depend heavily on nutrients like vitamins C and E, selenium, and glutathione. Poor diet, environmental exposures, and even chronic psychological stress can deplete these antioxidant reserves.

From my clinical observation, patients presenting with skin manifestations like atypical nevi often have other signs of systemic inflammation, such as joint pain, digestive issues, or brain fog. A skin lesion can indicate a more serious underlying issue.

Impaired Detoxification and Cellular Health

The body has sophisticated detoxification systems, primarily in the liver, but also in the gut, kidneys, and skin, designed to neutralize and excrete toxins. When these pathways become overburdened or genetically compromised, toxins can accumulate and contribute to cellular damage. In functional medicine, we assess these pathways and support them using targeted nutrients, botanicals, and lifestyle changes. This helps the body “take out the trash” and maintain a clean internal environment conducive to healthy cell replication.

An Integrative Treatment Approach: Combining Chiropractic, Nutrition, and Medical Oversight

Here is where our multidisciplinary model truly shines. Addressing a dysplastic nevus and, more importantly, the underlying risk factors, requires a multi-pronged strategy.

The Role of Chiropractic Care in Systemic Health

While many associate chiropractic care solely with back pain, its physiological impact is far broader. The nervous system is the body’s master controller, regulating everything from muscle function to immune response and inflammation.

• Neuro-Immunomodulation: Spinal misalignments, or vertebral subluxations, can interfere with nerve signals and disrupt normal communication between the brain and the body. Research suggests that chiropractic adjustments can modulate the autonomic nervous system, which plays a key role in regulating the immune system and inflammatory responses (Roy, Boucher, & Comtois, 2010). By restoring proper spinal biomechanics and neurological function, we can help downregulate systemic inflammation, creating a less hospitable environment for abnormal cell growth.
• Stress Reduction: Chiropractic adjustments have also been shown to reduce physiological stress markers. By calming the “fight-or-flight” sympathetic nervous system and promoting a “rest-and-digest” parasympathetic state, we can help mitigate chronic stress’s damaging effects on cellular health.

Functional Nutrition and Lifestyle Interventions

Following the excision, our focus shifts to prevention. Based on functional lab testing (which might include markers for inflammation, oxidative stress, and nutrient status), we develop a personalized plan.

• Anti-Inflammatory Diet: We guide patients toward a diet rich in whole foods, colorful plants, healthy fats (like omega-3s), and lean proteins. This provides the body with the phytonutrients and antioxidants needed to combat oxidative stress and quell inflammation.
• Targeted Supplementation: We may recommend supplements such as curcumin, fish oil, vitamin D, and specialized antioxidants to further support the body’s anti-inflammatory and detoxification pathways.
• Gut Health Restoration: Since a significant portion of the immune system resides in the gut, healing a leaky gut and rebalancing the microbiome is often a critical step in reducing systemic inflammation.

Dr. Cardenas’s role here is vital. She reviews our comprehensive plans and ensures there are no contraindications with any existing medical conditions or medications. She also provides the necessary medical clearance and oversight for our integrative protocols. This collaborative review ensures a safe, synergistic application of natural and conventional approaches. It defines the integrative care we provide at our El Paso clinic.

By combining the precise procedural care for the dysplastic nevus with a deep, functional investigation into its root causes, we empower our patients. They can not just treat a symptom, but also build a foundation of robust, resilient health from the inside out.

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References

• Becker, D. E., & Reed, K. L. (2006). Local Anesthetics: Review of Pharmacological Considerations. Anesthesia Progress, 53(3), 98–109. doi.org/10.2340/0003-3525(2006)53%5B98:LAROPC%5D2.0.CO;2
• Coussens, L. M., & Werb, Z. (2002). Inflammation and cancer. Nature, 420(6917), 860–867. doi.org/10.1038/nature01322
• Gawkrodger, D. J. (2012). Dermatology: An illustrated colour text (5th ed.). Churchill Livingstone.
• Roy, R. A., Boucher, J. P., & Comtois, A. S. (2010). Heart rate variability modulation after manipulation in healthy and painful subjects: a literature review. Journal of Manipulative and Physiological Therapeutics, 33(7), 558-566. doi.org/10.1016/j.jmpt.2010.08.005