Original article
Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border

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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.

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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    Funding sources: None.

    Conflicts of interest: None declared.

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