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Journal of the American Academy of Dermatology
Volume 71, n° 6
pages 1071-1076 (décembre 2014)
Doi : 10.1016/j.jaad.2014.08.025
accepted : 17 August 2014
Original Articles

The utility of re-excising mildly and moderately dysplastic nevi: A retrospective analysis
 

Lauren Strazzula, BA a, Priyanka Vedak, BA a, Mai P. Hoang, MD b, Arthur Sober, MD a, Hensin Tsao, MD, PhD a, Daniela Kroshinsky, MD, MPH a,
a Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 
b Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 

Reprint requests: Daniela Kroshinsky, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, #200, Boston, MA 02114.
Abstract
Background

The management of dysplastic nevi (DN) is a highly debated and controversial topic within the dermatology community. Clinicians agree that margin-positive severely DN should be removed with a surgical margin, however, there is disagreement surrounding the appropriate management of margin-positive mildly and moderately DN.

Objective

We sought to evaluate the utility of re-excising margin-positive mildly and moderately DN.

Methods

A retrospective chart review was conducted on all adult patients given the diagnosis of a biopsy-proven DN from 2010 through 2011. The primary outcomes were defined as the presence of melanocytic residuum in re-excisional specimens and a clinically significant change in diagnosis.

Results

A total of 1809 mildly and moderately DN were diagnosed from 2010 through 2011. In all, 765 (42.3%) of these lesions were found to have positive surgical margins during biopsy, and 495 (64.7) of the 765 lesions were subsequently re-excised. Melanocytic residuum was present in 18.2% of re-excisional specimens. Re-excision resulted in a clinically significant alteration of the diagnosis in only 1 case (0.2%).

Limitations

Limitations include retrospective design and inability to assess for malignant transformation given limited follow-up.

Conclusions

Re-excising mildly and moderately DN results in a low histopathological yield and rarely results in a clinically significant change in diagnosis. As such, clinical monitoring of margin-positive lesions may be warranted.

The full text of this article is available in PDF format.

Key words : dermatopathology, dysplastic nevus, melanoma, nevus, pigmented lesions, surgical management



 Funding sources: None.
 Conflicts of interest: None declared.



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