Original articleFavorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border
Section snippets
Methods
The study was approved by the Mayo Clinic Institutional Review Board. Retrospective review of our Medical Index for appropriate codes adapted from the International Classification of Diseases, Eighth Revision, of all melanocytic lesions diagnosed as either “junctional nevus” or “compound nevus” that were removed from patients residing in Olmsted County, who were evaluated in the Department of Dermatology at Mayo Clinic, Rochester, Minn, between January 1, 1980, and December 31, 1989, was
Results
Between 1980 and 1989, 3398 specimens were diagnosed as junctional nevus or compound nevus (Fig 1). Our histopathologic review revealed that 1179 of 3398 nevi approached a microscopic border, and we identified 117 of 1179 (10%) that would be diagnosed as HDN by current criteria. Two of these 117 were excluded, because review of the medical records indicated that the specimens were incisional biopsies. Of the 115 HDNs that met all 4 inclusion criteria, 66 were graded as mildly dysplastic, 42 as
Discussion
Our goal was to answer the question: if a patient receives a diagnosis of HDN approaching a microscopic border and re-excision is not performed, what is the long-term risk of melanoma developing at that site? Our study demonstrates that incomplete or narrow removal of HDNs does not appear to be associated with development of melanoma at the site or with metastatic melanoma during an average follow-up period of nearly 2 decades. Other investigators, with smaller case series and/or shorter
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Dysplastic nevus part II: Dysplastic nevi: Molecular/genetic profiles and management
2023, Journal of the American Academy of DermatologyCitation Excerpt :Studies seeking to clarify whether HDN should be re-excised have focused predominantly on clinical follow-up to determine melanoma development. A 2018 systematic review screened 5293 articles and included 12 in the analysis (11 were retrospective chart reviews and 1 was a cross-sectional and cohort study), resulting in the inclusion of 2673 HDN with dysplasia ranging from mild to severe.36,37,40-50 No melanomas developed following biopsy diagnosis of HDN according to 9 studies, and 3 studies reported development of 11 melanomas at a biopsy site: 5 (0.44%) were diagnosed in re-excision specimens and 6 (0.39%) in HDN that were subject to observation following biopsy.
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2020, Actas Dermo-SifiliograficasPathologists' agreement on treatment suggestions for melanocytic skin lesions
2020, Journal of the American Academy of DermatologyCitation Excerpt :Pathologists were also given only 4 different options for treatment suggestions, which may have limited the ability to fully communicate their suggestions. Furthermore, we are currently refining the MPATH-Dx schema, in light of new research evidence on class II and III categories, and we are aware that there is disagreement on some of the MPATH-Dx classifications and their respective treatment recommendations.2-5 Strengths of our study include the broad spectrum and high number of cases and the large number of participating pathologists from across the United States.
Recurrence of moderately dysplastic nevi with positive histologic margins
2017, Journal of the American Academy of DermatologyDysplastic nevi with severe atypia: Long-term outcomes in patients with and without re-excision
2017, Journal of the American Academy of DermatologyThe ethics of mole miners
2016, Journal of the American Academy of DermatologyCitation Excerpt :Although melanomas can be identified histologically in association with a melanocytic nevus, this association is as likely to arise in a common nevus as in DN.3 Studies also yield no evidence that a histologically defined DN evolves into a melanoma.4 In addition, when a DN with positive biopsy margins is re-excised, the pathology shows only a scar in the majority of cases, as was demonstrated in Dr MM's re-excisions.5
Funding sources: None.
Conflicts of interest: None declared.