Recurrence of moderately dysplastic nevi with positive histologic margins

Surgical re-excision vs. observation for histologically dysplastic naevi: a systematic review of associated clinical outcomes

“…Only one study was not conducted in the U.S.A. (it was in New Zealand). More than half (seven of 12, 58%) of the included studies had primary outcomes focused on the development of melanoma at the site of HDN biopsy, with a third of studies assessing recurrence of HDN (four of 12, 33%), and one study assessing both outcomes (one of 12, 8%) . Half of the studies did not provide any demographic information about the study population …”

“…The duration of follow‐up time was not specified at all in a quarter of the studies, a minimum duration of follow‐up was specified in three studies (at least 2 years; at least 5 years) and a maximum duration of follow‐up was specified in part of one study (less than 5 years) . When quantified, follow‐up was less than 5 years (range 2–16 weeks; mean 3·56 years, range 1·17–8·72 years) in two studies, it was between 5 and 10 years in two studies (mean ± SD 5·5 ± 4·6 years; mean 6·17 years, range 5·03–9·78 years) and greater than 10 years in two studies (median 11·9 years, interquartile range 9–14·8 years; mean 17·4 years, range: 0–29·9 years).…”

“…Melanomas developed in only three of the studies, which may reflect differences in the proportion of severe HDNs or differences in the patient populations recruited. Additionally, the primary outcome of interest, melanoma development, was not directly addressed in four of the included articles . Most of the included studies were retrospective and many did not have demographic or other patient data; and the vast majority did not have comparison groups.…”

Recurrence, evolution, and re-excision of moderately dysplastic nevi

“…To the Editor: I read with great interest the fascinating and valuable article by Hiscox et al on recurrence of moderately dysplastic nevi (MDN). 1 The authors argue that their findings ''support the conclusion of the Pigmented Lesion Subcommittee that incompletely excised MDN do not require re-excision.'' While the authors' study indeed adds to the literature, and supports the findings of another recent study 2 assessing a similar clinical question, several important caveats should be noted.…”

Partial biopsies and persistent nevi: Communicate clearly and proceed with caution

“…3 We feel it is premature to conclude that ''incompletely excised moderately dysplastic nevi do not require re-excision.'' 1 We favor the carefully worded conclusions of Kim et al 5 that ''observation may be a reasonable option for management of moderate DN with positive histologic margins without clinically apparent residual pigmentation,'' and Fleming et al's 3 caution that ''partial biopsies of pigmented lesions suspicious for melanoma may lead to delayed melanoma diagnosis and should be discouraged.'' Ignoring a pathologist's recommendation to completely excise a lesion or his or her stance on the management of moderately atypical nevi can be perilous.…”