Addressing the Knowledge Gap in Clinical Recommendations for Management and Complete Excision of Clinically Atypical Nevi/Dysplastic Nevi

Abstract

This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.

Recurrence of moderately dysplastic nevi with positive histologic margins

“…1 They note that, ''.observation may be a reasonable option for management of MDN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.'' 1 This conclusion is based on several studies that look at the clinical follow-up of MDN, including a small minority that showed histologically positive margins.…”

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

“…). All articles evaluated by the recent consensus statement by the Melanoma Prevention Working Group were among the articles that met inclusion criteria …”

“…To date no such trial has been conducted, and it is unlikely that one will be performed for this clinical question given costs. There has been a proposal by the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group of collecting multicentre prospective data regarding outcomes for observed vs. re‐excised dysplastic naevi . Hopefully with prospective studies such as these, higher quality retrospective cohort studies, uniform pathology reporting and long‐term outcomes analyses we will be able to have stronger evidence about what types of patients and associated histological features deem re‐excision vs. observation as the preferred intervention balancing both benefits and harms.…”

“…Although management of HDN remains controversial, dermatologists are increasingly embracing observation as management rather than re‐excision depending on the degree of histological dysplasia and whether the biopsy specimen was histologically transected . There have been several studies examining clinical outcomes associated with observation vs. re‐excision for HDN and a recent consensus statement by the Pigmented Lesion Subcommittee of the Melanoma Prevention Working Group recommended observation rather than re‐excision as a reasonable approach to management of mild and moderate HDN including those histologically transected …”

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

“…In addition, this study highlights the wide range of treatment suggestions for melanocytic lesions that lack national treatment guidelines. 23,24 Physician experience and training influenced whether pathologists made suggestions, with dermatopathology training trending towards more conservative treatment suggestions for mild and moderately dysplastic nevi. For melanomas and melanoma in situ, pathologists typically made treatment suggestions in accordance with the established NCCN guidelines.…”