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Baeza-Hernández G, Rubio-Aguilera RF, Martínez-Morán C, Álvarez-Garrido H, Garrido-Ríos AA, Borbujo J. [Translated article] Survey on the Management of Dysplastic Nevus by Dermatologists in the Center-Spain Section of the Spanish Academy of Dermatology and Venereology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T850-T857. [PMID: 37734540 DOI: 10.1016/j.ad.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. MATERIAL AND METHODS We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). RESULTS We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists' attitudes. CONCLUSIONS Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases.
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Affiliation(s)
- G Baeza-Hernández
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | - R F Rubio-Aguilera
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - C Martínez-Morán
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - H Álvarez-Garrido
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - A A Garrido-Ríos
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - J Borbujo
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Baeza-Hernández G, Rubio-Aguilera RF, Martínez-Morán C, Álvarez-Garrido H, Garrido-Ríos AA, Borbujo J. Survey on the Management of Dysplastic Nevus by Dermatologists in the Center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV). ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:850-857. [PMID: 37482291 DOI: 10.1016/j.ad.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma. MATERIAL AND METHODS We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm). RESULTS We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists' attitudes. CONCLUSIONS Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases.
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Affiliation(s)
- G Baeza-Hernández
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | - R F Rubio-Aguilera
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - C Martínez-Morán
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - H Álvarez-Garrido
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - A A Garrido-Ríos
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - J Borbujo
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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Spaccarelli N, Drozdowski R, Peters MS, Grant-Kels JM. Dysplastic nevus part II: Dysplastic nevi: Molecular/genetic profiles and management. J Am Acad Dermatol 2023; 88:13-20. [PMID: 36252690 DOI: 10.1016/j.jaad.2022.05.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
Abstract
Dermatologists frequently see patients with clinically atypical nevi and dermatopathologists interpret histologically dysplastic nevi on a near-daily basis, but there is great variability in the definition and management of such lesions. This part of the CME review focuses on information published since the previous comprehensive review (2012), with emphasis on molecular and genetic attributes of histologically dysplastic nevi and clinical management.
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Affiliation(s)
- Natalie Spaccarelli
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columubs, Ohio
| | - Roman Drozdowski
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Margot S Peters
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jane M Grant-Kels
- Departments of Dermatology, Pathology and Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida.
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The Emperor's New Clothes: A Critique of the Current WHO Classification of Malignant Melanoma. Am J Dermatopathol 2020; 42:989-1002. [PMID: 32852290 DOI: 10.1097/dad.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The World Health Organization's classification of skin tumors of 2018 presents melanoma as a loose assembly of independent biologic entities, each of which is characterized by a distinctive constellation of clinical, histopathologic, and molecular findings that evolve through different pathways of lesional progression from a benign to an intermediate and, ultimately, malignant tumor. The alleged pathways, however, are based on vague correlations and fail to take into account the common occurrence of lesions that cannot be assigned to either of them. Moreover, there is no such thing as a lesional progression. The evolvement of neoplasms is always a clonal and, therefore, initially focal event. In the majority of melanomas, there is no evidence of a juxtaposition of a benign, intermediate, and malignant portion. Occasionally, a melanoma may develop within the confines of a melanocytic nevus, but a nevus cannot transform into melanoma. The concept of lesional progression merely serves to handle problems of differential diagnosis because it obscures and, in fact, denies the difference between benign and malignant neoplasms. In the current classification of the World Health Organization, every lesion is said to bear some risk of malignant progression, intermediate categories are recognized for all alleged pathways, and no distinction is made between "high-grade dysplasia" and melanoma in situ. Differentiation between benign and malignant neoplasms of melanocytes may be difficult, but the concept of lesional progression does not address those problems; it merely offers evasions under the disguise of diagnoses.
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Pournamdari AB, Tkachenko E, Barbieri J, Adamson AS, Mostaghimi A. A State-of-the-Art Review Highlighting Medical Overuse in Dermatology, 2017-2018. JAMA Dermatol 2019; 155:1410-1415. [DOI: 10.1001/jamadermatol.2019.3064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ashley B. Pournamdari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Medicine, University of California, San Francisco
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Adewole S. Adamson
- Division of Dermatology, Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hornberger J, Siegel DM. Economic Analysis of a Noninvasive Molecular Pathologic Assay for Pigmented Skin Lesions. JAMA Dermatol 2019; 154:1025-1031. [PMID: 29998292 DOI: 10.1001/jamadermatol.2018.1764] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A recently described noninvasive gene expression test (the pigmented lesion assay [PLA]) with adhesive patch-based sampling has the potential to rule out melanoma and the need for surgical biopsy of pigmented lesions suggestive of melanoma with a negative predictive value of 99% compared with 83% for the histopathologic standard of care. The cost implications of using this molecular test vs visual assessment followed by biopsy and histopathologic assessment (VAH) have not been evaluated. Objective To determine potential cost savings of PLA use vs the VAH pathway. Design, Setting, and Participants This health economic analysis performed from a US payer perspective was based on consensus treatment guidelines and fee schedules from the Centers for Medicare & Medicaid Services. Data for model input were derived from routine use of the test in US dermatology practices and literature. Participants included patients with primary cutaneous pigmented lesions suggestive of melanoma. Data were analyzed from February 8 to December 1, 2017. Main Outcomes and Measures The primary analysis consisted of the relative reduction in costs of diagnostic surgical procedures for PLA vs VAH management. Additional analyses included stage-related treatment costs associated with delays in diagnosis. Results In the cost analysis for this economic model, the relative reduction in surgical procedure costs (biopsy and subsequent excision), assuming $0 for the PLA to facilitate multiple comparison scenarios, was -$395 compared with VAH. The relative reduction in stage-related treatment costs associated with the PLA was -$433 compared with VAH, primarily associated with avoidance of delays due to false-negative diagnoses. Surveillance costs were reduced by -$119 with the PLA. The total cost of fully adjudicating a lesion suggestive of melanoma by VAH was $947. At a mean selling price reference point for PLA of $500, cost savings of $447 (47%) per lesion tested could be realized. Conclusions and Relevance The results of this analysis suggest that the PLA reduces cost and may improve the care of patients with primary pigmented skin lesions suggestive of melanoma.
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Affiliation(s)
- John Hornberger
- Department of Internal Medicine, Stanford University, Stanford, California.,Cedar Associates, Menlo Park, California
| | - Daniel M Siegel
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn.,Department of Dermatology, Brooklyn Veterans Administration Medical Center, Brooklyn, New York
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Duncan JR, Purnell JC, Stratton MS, Pavlidakey PG, Huang C, Phillips CB. Negative predictive value of biopsy margins of dysplastic nevi: A single-institution retrospective review. J Am Acad Dermatol 2019; 82:87-93. [PMID: 31326466 DOI: 10.1016/j.jaad.2019.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biopsies of dysplastic nevi processed by bread-loafing allow for limited margin assessment; however, reported biopsy margins often influence management. OBJECTIVE To evaluate the negative predictive value of biopsy margins of dysplastic nevi. METHODS A retrospective search of a single academic institution's pathology database was conducted to identify all biopsy specimens of dysplastic nevi between January 1, 2015, and December 31, 2017. Biopsy specimen margin assessments were compared with excision pathology reports to calculate negative predictive value and to assess the frequency of residual nevus on excision after positive biopsy margins. RESULTS A total of 1245 dysplastic nevi from 934 patients were identified. Clear biopsy margins had a negative predictive value for the absence of residual nevus on excision of 87.3% for dysplastic nevi of moderate atypia or greater. Residual nevus was identified on excision in 29.41% of cases of dysplastic nevi of moderate atypia or greater when initial biopsy margins were positive. LIMITATIONS This was a retrospective, single-institution study. The calculations likely overestimate the true negative predictive value of biopsy margins because of processing of excision specimens by bread-loafing. CONCLUSIONS This study provides additional evidence that reported biopsy margins are not representative of true margin status.
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Affiliation(s)
- James Robert Duncan
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama.
| | - Joseph Chase Purnell
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | | | - Peter G Pavlidakey
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | - Conway Huang
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
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Kim CC, Berry EG, Marchetti MA, Swetter SM, Lim G, Grossman D, Curiel-Lewandrowski C, Chu EY, Ming ME, Zhu K, Brahmbhatt M, Balakrishnan V, Davis MJ, Wolner Z, Fleming N, Ferris LK, Nguyen J, Trofymenko O, Liu Y, Chen SC. Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol 2018; 154:1401-1408. [PMID: 30304348 PMCID: PMC6583364 DOI: 10.1001/jamadermatol.2018.3359] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/10/2018] [Indexed: 11/14/2022]
Abstract
Importance Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P < .001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P = .01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.
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Affiliation(s)
- Caroline C. Kim
- Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth G. Berry
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Michael A. Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan M. Swetter
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Geoffrey Lim
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Douglas Grossman
- Department of Dermatology, Huntsman Cancer Institute, University of Utah, Salt Lake City
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Clara Curiel-Lewandrowski
- Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
| | - Emily Y. Chu
- Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Michael E. Ming
- Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Kathleen Zhu
- University of Massachusetts Medical School, Worcester
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Morehouse School of Medicine, Atlanta, Georgia
| | - Vijay Balakrishnan
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Michael J. Davis
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
| | - Zachary Wolner
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nathaniel Fleming
- Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Laura K. Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Oleksandr Trofymenko
- Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
| | - Yuan Liu
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C. Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
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Nelson KC, Grossman D, Kim CC, Chen SC, Curiel-Lewandrowski CN, Grichnik JM, Kirkwood JM, Leachman SA, Marghoob AA, Swetter SM, Venna SS, Ming ME. Management strategies of academic pigmented lesion clinic directors in the United States. J Am Acad Dermatol 2018; 79:367-369. [DOI: 10.1016/j.jaad.2017.12.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 12/19/2017] [Accepted: 12/25/2017] [Indexed: 11/28/2022]
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Vuong KT, Walker J, Powell HB, Thomas NE, Jonas DE, Adamson AS. Surgical re-excision vs. observation for histologically dysplastic naevi: a systematic review of associated clinical outcomes. Br J Dermatol 2018; 179:590-598. [PMID: 29570779 DOI: 10.1111/bjd.16557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The management of histologically dysplastic naevi (HDN) with re-excision vs. observation remains controversial because of lack of evidence about associated melanoma outcomes. OBJECTIVES To assess published data on the development of biopsy-site primary cutaneous melanoma among biopsy-proven HDN managed with either re-excision or observation. METHODS A systematic review of all published data: a total of 5293 records were screened, 18 articles were assessed in full text and 12 studies met inclusion criteria. No controlled trials were identified. RESULTS Most studies (11 of 12, 92%) were retrospective chart reviews, and one was both a cross-sectional and cohort study. Many studies (nine of 12, 75%) had no head-to-head comparison groups and either only reported HDN that were re-excised or observed. A total of 2673 (1535 observed vs. 1138 re-excised) HDN of various grades were included. Follow-up varied between 2 weeks and 30 years. Nine studies reported that no melanomas developed. Eleven biopsy-site melanomas developed across three of the studies, six among observed lesions (0·39%) and five among re-excised lesions (0·44%). CONCLUSIONS Based upon the available evidence the rates of biopsy-site primary melanoma were similarly low among observed lesions and re-excised lesions. This suggests that HDNs can be observed with minimal adverse melanoma-associated outcomes. However, all included articles were of low quality and further prospective trials could better guide clinical decision making.
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Affiliation(s)
- K T Vuong
- University of North Carolina School of Medicine, Chapel Hill, NC, U.S.A
| | - J Walker
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
| | - H B Powell
- University of North Carolina School of Medicine, Chapel Hill, NC, U.S.A
| | - N E Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
| | - D E Jonas
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
| | - A S Adamson
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, U.S.A
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11
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Terushkin V, Ng E, Stein JA, Katz S, Cohen DE, Meehan S, Polsky D. A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi. J Am Acad Dermatol 2017; 77:1096-1099. [DOI: 10.1016/j.jaad.2017.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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12
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Wall N, De'Ambrosis B, Muir J. The management of dysplastic naevi: a survey of Australian dermatologists. Australas J Dermatol 2017; 58:304-307. [PMID: 29094336 DOI: 10.1111/ajd.12720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES The management of dysplastic naevi based on histopathological grading is a contentious issue. Comprehensive management guidelines are lacking and the approach taken varies between clinicians. The authors sought to understand how Australian dermatologists approach the management of biopsy-proven dysplastic naevi, and the impact of grading of dysplasia upon this management. METHODS In total, 547 Fellows of the Australasian College of Dermatologists were surveyed and 218 responses were collected (40% response rate). RESULTS Although all dermatologists surveyed would re-excise an incompletely removed severely dysplastic naevus, opinion was divided over whether to treat such a lesion as an in situ melanoma or a dysplastic naevus, with 55% of respondents using a 5-mm margin and the remainder opting for narrow margin re-excision. When the same lesion was reported to be clear of margins by 1 mm after biopsy and the clinical suspicion for melanoma was high, 44% would re-excise with a 5-mm margin. CONCLUSIONS The approach of Australian dermatologists to the management of dysplastic naevi varies between clinicians, reflecting the problems raised by the validity of histopathological grading.
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Affiliation(s)
- Nerilee Wall
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brian De'Ambrosis
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jim Muir
- South East Dermatology, Brisbane, Queensland, Australia.,Department of Dermatology, Mater Hospital, Brisbane, Queensland, Australia
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