A nongrading histologic approach to Clark (dysplastic) nevi: A potential to decrease the excision rate - 18/12/15
Abstract |
Background |
Despite a lack of evidence that dysplastic nevi are precursors to melanoma, a large proportion of dermatologists continue to treat them as such. Emerging data suggest that histologic grading approach may result in many unnecessary excisions.
Objective |
Using a nongrading approach to diagnosis of Clark/dysplastic nevi, the current study sought to define and determine the diagnostic uncertainty rate, and to report on the results of re-excisions of such lesions.
Methods |
All melanocytic nevi submitted to an academic dermatopathology laboratory between January 1, 2007, and December 31, 2013, were categorized. The number of Clark nevi recommended for re-excision divided by the total number of Clark nevi was taken to be the diagnostic uncertainty rate.
Results |
This nongrading approach resulted in an excision recommendation/diagnostic uncertainty rate of 11.1%. In 2% of the excised specimens, the diagnosis was changed to melanoma.
Limitations |
The study was performed at a single institution, and assigned diagnoses could not be verified other than by the diagnosing dermatopathologists. Lesions that were not submitted as re-excision specimens could have altered the results had they been available for evaluation.
Conclusion |
Compared with previously reported excision rates, the current study shows that the nongrading approach to Clark nevi results in a lower excision rate while still maintaining a low rate of change in diagnosis similar to the grading approach.
Le texte complet de cet article est disponible en PDF.Key words : atypia, biopsy, Clark nevus, diagnostic uncertainty, dysplastic nevus, excision, melanoma
Plan
Funding sources: None. |
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Conflicts of interest: None declared. |
Vol 74 - N° 1
P. 68-74 - janvier 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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