Dr removed small (4mm) mole. said he is 99.9% confident it is aytipical from visual/dermoscope evaluation and that he would be shocked if otherwis. would he be so confident if there was a concern?

Experience: A large body of experience over time allows a physician to develop a sense of confidence when visually inspecting a skin lesion. Most of the time, they are accurate. A biopsy sent to pathology is the best way to confirm our diagnoses.

Most moles: Removed will not be cancer. It may or may not even have abnormal cells, or atypia. It should be fine, i think 1/1000 is a fair estimate, if not less chance, for having a 4 mm mole that is a melanoma. Gd luc.

Wait fot the path: Best advice is to wait for the final pathology.