Original article
Low rates of clinical recurrence after biopsy of benign to moderately dysplastic melanocytic nevi

https://doi.org/10.1016/j.jaad.2009.06.080Get rights and content

Background

Little is known about the recurrence/persistence rates of dysplastic nevi (DN) after biopsy, and whether incompletely removed DN should be re-excised to prevent recurrence.

Objective

Our purpose was to determine the recurrence rates of previously biopsied DN, and to assess whether biopsy method, margin involvement, congenital features, epidermal location, and degree of dysplasia are associated with recurrence.

Methods

Patients having a history of a “nevus biopsy” at least 2 years earlier were assessed for clinical recurrence. Slides of original lesions were re-reviewed by a dermatopathologist.

Results

A total of 271 nevus biopsy sites were assessed in 115 patients. Of 195 DN with greater than 2 years of follow-up, 7 (3.6%) demonstrated recurrence on clinical examination. In all, 98 DN had a follow-up period of at least 4 years with no clinical recurrence. Of 61 benign nevus biopsy sites examined, clinical recurrence was observed in two (3.3%). For all nevi, recurrence was significantly associated with shave biopsy technique but not with nevus dysplasia or subtype, or the presence of positive margin or congenital features.

Limitations

Most biopsies were performed in a pigmented lesion clinic at a single tertiary referral center. Determinations of nevus recurrence were made on clinical rather than histologic grounds, and follow-up times were limited in some cases.

Conclusion

In this cohort, rates of clinical recurrence after biopsy of DN and benign nevi were extremely low. Re-excision of nevi, including mildly to moderately DN with a positive margin, may not be necessary.

Section snippets

Patients and nevus biopsies

This study was approved by our university institutional review board. Patients were recruited from our pigmented lesion clinic, in which approximately 7 new patients are seen each week and more than 1000 patients with history of numerous or atypical nevi and/or personal or family history of melanoma are monitored. The charts of patients scheduled for examination were reviewed before their visit to determine whether any previously biopsied melanocytic nevi were appropriate for the study. Earlier

Rates of nevus recurrence

During an 8-month period, 271 sites of previously biopsied melanocytic nevi were assessed for clinical recurrence in 115 patients (Table I). In most cases, nevi at the follow-up visit presented as a well-healed hypopigmented scar (Fig 1, A). In some cases, on the other hand, pigmentation was seen within the scar (Fig 1, B), and interpreted as nevus recurrence. After histologic re-evaluation of original biopsy specimens, 195 lesions were classified as DN, 61 were classified as BN, and 15 were

Discussion

It is clear from the literature that patients with DN are at increased risk for developing melanoma.9, 10, 11 Although 20% to 50% of melanomas appear to arise from a pre-existing nevus,12, 13, 14 the annual risk of individual nevi transforming into a melanoma is extremely low–estimated to be only 1 in 200,000.15 The annual risk is higher for DN (estimated 1 in 10,000),16 raising the question of whether incompletely removed DN should be re-excised with clear margins to prevent potential

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    Supported by the Department of Dermatology, the Huntsman Cancer Foundation, and the National Institutes of Health (Dr Grossman)

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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