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  • Title: Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border.
    Author: Hocker TL, Alikhan A, Comfere NI, Peters MS.
    Journal: J Am Acad Dermatol; 2013 Apr; 68(4):545-551. PubMed ID: 23127472.
    Abstract:
    BACKGROUND: Patients with multiple clinically dysplastic nevi are at increased risk for development of melanoma. However, the risk of melanoma arising in a histologically dysplastic nevus (HDN) is unknown. OBJECTIVE: We sought to determine the rate of melanoma development in patients with HDNs that approached a microscopic border but were not re-excised. METHODS: We performed a retrospective study of patients evaluated in our dermatology department from January 1, 1980, to December 31, 1989, who had a HDN that extended to within 0.2 mm of a microscopic punch, shave, or excision border and was not re-excised. RESULTS: The average follow-up in our cohort of 115 patients was 17.4 years (range: 0.0-29.9): 82 patients (71.3%) were followed up for longer than 10 years, 78 (67.8%) longer than 15 years, and 73 (63.4%) had more than 20 years of follow-up; 66 of 115 nevi were mildly dysplastic, 42 moderately dysplastic, and 7 had severe dysplasia. No patient developed metastatic melanoma or melanoma at the site of removal of a HDN. LIMITATIONS: This was a retrospective study performed at 1 large academic medical center. CONCLUSION: During a long-term follow-up period, no patient developed melanoma at the site of an incompletely or narrowly removed HDN, providing evidence that routine re-excision of mildly or moderately dysplastic nevi may not be necessary.
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