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22 May 2025
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Retrospective multicenter study on severely dysplastic melanocytic nevi: evaluating the need for re-excision and the risk of recurrence or progression
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Severely dysplastic melanocytic nevi (SMD) are histologically challenging lesions with no consensus on optimal management. While complete excision is widely recommended, the necessity of additional reexcision remains debated. This retrospective, multicenter observational cohort study evaluated the risk of recurrence and disease progression in patients with SMD by comparing those who underwent a single complete excision to those who underwent a secondary widening procedure with 5 mm margins. A total of 226 patients (230 SMD lesions) were included, with diagnoses based on the 2018 World Health Organization (WHO) criteria. Among them, 13.5% underwent re-excision despite clear margins, while 86.5% were followed clinically. Over a minimum 5-year follow-up period, no patient in either group experienced recurrence at the excision site or progression to melanoma. These findings suggest that complete excision with clear margins is sufficient for managing SMD, with no added benefit from routine re-excision. Avoiding unnecessary surgical procedures could reduce patient anxiety, healthcare costs, and surgical morbidity. Given the lack of standardized guidelines, further prospective studies are needed to refine clinical decision-making for SMD management.
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Clark WH Jr, Reimer RR, Greene M, et al. Origin of familial malignant melanomas from heritable melanocytic lesions: the B-K mole syndrome. Arch Dermatol 1978;114:732-8. DOI: https://doi.org/10.1001/archderm.1978.01640170032006
Clemente C, Cochran AJ, Elder DE, et al. Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme. Hum Pathol 1991;22:313-9. DOI: https://doi.org/10.1016/0046-8177(91)90078-4
Drozdowski R, Spaccarelli N, Peters MS, et al. Dysplastic nevus part I: historical perspective, classification, and epidemiology. J Am Acad Dermatol 2023;88:1-10. DOI: https://doi.org/10.1016/j.jaad.2022.04.068
Elder DE, Massi D, Scolyer RA, et al. WHO classification of skin tumours. 4th ed. International Agency for Research on Cancer; 2018.
Shea CR, Vollmer RT, Prieto VG. Correlating architectural disorder and cytologic atypia in Clark (dysplastic) melanocytic nevi. Hum Pathol 1999;30:500-5. DOI: https://doi.org/10.1016/S0046-8177(99)90191-0
NIH Consensus Conference. Diagnosis and treatment of early melanoma. JAMA 1992;268:1314-9. DOI: https://doi.org/10.1001/jama.1992.03490100112037
Spaccarelli N, Drozdowski R, Peters MS, et al. Dysplastic nevus part II: molecular/genetic profiles and management. J Am Acad Dermatol 2023;88:13-20. DOI: https://doi.org/10.1016/j.jaad.2022.05.071
Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous melanoma: I. common and atypical naevi. Eur J Cancer 2005;41:28-44. DOI: https://doi.org/10.1016/j.ejca.2004.10.015
Barnhill RL, Piepkorn MW, Duncan LM, et al. MPATH-Dx version 2.0 schema for melanocytic lesions: a robust tool for standardized diagnostic reporting. Clin Dermatol 2024;S0738081X24001767. DOI: https://doi.org/10.1016/j.clindermatol.2024.09.007
Vuong KT, Walker J, Powell HB, et al. Surgical re-excision vs. observation for histologically dysplastic naevi: a systematic review of associated clinical outcomes. Br J Dermatol 2018;179:590-8. DOI: https://doi.org/10.1111/bjd.16557
Baeza-Hernández G, Rubio-Aguilera RF, Martínez-Morán C, et al. Survey on the management of dysplastic nevus by dermatologists in the Center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV). Actas Dermosifiliogr 2023;114:850-7. DOI: https://doi.org/10.1016/j.ad.2023.09.016
Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 1: diagnostics: update 2022. Eur J Cancer 2022;170:236-55. DOI: https://doi.org/10.1016/j.ejca.2022.03.008
Kim CC, Swetter SM, Curiel-Lewandrowski C, et al. Addressing the knowledge gap in clinical recommendations for management and complete excision of clinically atypical nevi/dysplastic nevi: pigmented lesion subcommittee consensus statement. JAMA Dermatol 2015;151:212. DOI: https://doi.org/10.1001/jamadermatol.2014.2694
Kim CC, Berry EG, Marchetti MA, et al. Risk of subsequent cutaneous melanoma in moderately dysplastic nevi excisionally biopsied but with positive histologic margins. JAMA Dermatol 2018;154:1401. DOI: https://doi.org/10.1001/jamadermatol.2018.3359
Nelson KC, Grossman D, Kim CC, et al. Management strategies of academic pigmented lesion clinic directors in the United States. J Am Acad Dermatol 2018;79:367-9. DOI: https://doi.org/10.1016/j.jaad.2017.12.069
Barnhill RL, Elder DE, Piepkorn MW, et al. Revision of the melanocytic pathology assessment tool and hierarchy for diagnosis classification schema for melanocytic lesions: a consensus statement. JAMA Netw Open 2023;6:e2250613. DOI: https://doi.org/10.1001/jamanetworkopen.2022.50613
Garbe C, Amaral T, Peris K, et al. European consensus-based interdisciplinary guideline for melanoma. Part 2: treatment - update 2022. Eur J Cancer 2022;170:256-84. DOI: https://doi.org/10.1016/j.ejca.2022.04.018
Soleymani T, Swetter SM, Hollmig ST, et al. Adequacy of conservative 2- to 3-mm surgical margins for complete excision of biopsy-proven severely dysplastic nevi: retrospective case series at a tertiary academic institution. J Am Acad Dermatol 2020;83:254-5. DOI: https://doi.org/10.1016/j.jaad.2019.12.077
Hocker TL, Alikhan A, Comfere NI, et al. Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border. J Am Acad Dermatol 2013;68:545-51. DOI: https://doi.org/10.1016/j.jaad.2012.09.031
Wall N, De’Ambrosis B, Muir J. The management of dysplastic naevi: a survey of Australian dermatologists. Australas J Dermatol 2017;58:304-7. DOI: https://doi.org/10.1111/ajd.12720
Sapra P, Rosen C, Siddha S, et al. Dysplastic nevus: management by Canadian dermatologists. J Cutan Med Surg 2015;19:457-63. DOI: https://doi.org/10.1177/1203475415575234
Engeln K, Peters K, Ho J, et al. Dysplastic nevi with severe atypia: long-term outcomes in patients with and without re-excision. J Am Acad Dermatol 2017;76:244-9. DOI: https://doi.org/10.1016/j.jaad.2016.08.054
Cohen LM, Hodge SJ, Owen LG, et al. Atypical melanocytic nevi: clinical and histopathologic predictors of residual tumor at reexcision. J Am Acad Dermatol 1992;27:701-6. DOI: https://doi.org/10.1016/0190-9622(92)70241-7
Abello-Poblete MV, Correa-Selm LM, Giambrone D, et al. Histologic outcomes of excised moderate and severe dysplastic nevi. Dermatol Surg 2014;40:40-5. DOI: https://doi.org/10.1111/dsu.12391
Armour K, Mann S, Lee S. Dysplastic naevi: to shave, or not to shave? A retrospective study of the use of the shave biopsy technique in the initial management of dysplastic naevi. Australas J Dermatol 2005;46:70-5. DOI: https://doi.org/10.1111/j.1440-0960.2005.00144.x
Semsarian CR, Ma T, Nickel B, et al. Do we need to rethink the diagnoses melanoma in situ and severely dysplastic naevus? Br J Dermatol 2022;186:1030-2. DOI: https://doi.org/10.1111/bjd.21010
How to Cite
Retrospective multicenter study on severely dysplastic melanocytic nevi: evaluating the need for re-excision and the risk of recurrence or progression. (2025). Dermatology Reports. https://doi.org/10.4081/dr.2025.10349
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