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

Abstract

Based upon the available evidence the rates of biopsy-site primary melanoma were similarly low among observed lesions and re-excised lesions. This suggests that HDNs can be observed with minimal adverse melanoma-associated outcomes. However, all included articles were of low quality and further prospective trials could better guide clinical decision making.

Incidence of cutaneous melanoma in patients with histologically confirmed dysplastic naevus: A follow‐up study in a large UK Healthcare Trust

“…Opinion is divided regarding their definition, histological grading, clinical significance and risk of subsequently developing cutaneous melanoma (CM). A recent systematic review by Vuong et al 1 evaluated the outcomes of observed versus re-excised histologically confirmed DN, with data largely drawn from North American centres. The recent multicentre study by Kim et al 2 helped to further elucidate the risk of subsequent cutaneous melanoma in patients with DN and guide pragmatic management of moderately severe DN, but there remains a lack of overarching consensus guidance for clinicians and a notable paucity of outcome data in the United Kingdom.…”

Observation of Moderately Dysplastic Nevi With Positive Margins

“…These findings further add to the growing body of evidence that clinical observation is a reasonable strategy to managing dysplastic nevi, even those with moderate dysplasia and positive histologic margins. 12 The data from Kim et al 11 are a welcome addition to the relative paucity of evidence-based literature to guide the management of dysplastic nevi. However, clinicians must interpret these results in the context of the study design.…”

Highlighting the need for prospective randomized studies on the management of dysplastic naevi

“…To address the utility of DN re‐excision, Vuong et al . conducted a thorough and comprehensive systematic review, analysing all published data on the development of primary cutaneous melanoma at biopsy sites of DN . They sought to analyse differences in melanoma occurring in biopsy‐proven DN managed with re‐excision vs. observation.…”

“…They found 11 total melanomas: five in 1138 re‐excised DN (0·44%) and six in 1535 observed DN (0·39%). Of the melanomas arising in observed DN, five of the six were initially only partially biopsied, signifying potential sampling error . Their data suggest that there is a similarly low likelihood of melanoma development in biopsy‐proven DN managed with re‐excision or observation and also underscores the risk of missing a melanoma in partial biopsies of atypical melanocytic lesions.…”

“…This systematic review provides useful practice recommendations based on the data available on the subject, while highlighting the fact that the only studies published to date have low‐quality evidence according to the Oxford Centre for Evidence‐Based Medicine rating scale . The majority (11 of 12, 92%) of studies included were retrospective chart reviews and single‐arm studies (9 of 12, 75%), while only half provided demographic information on the study population.…”