November 27, 2018

Observation of moderately dysplastic nevi excisionally biopsied with positive histologic margins may be an effective management option.

An investigation recently published in JAMA Dermatology suggests that observation of excised moderately dysplastic nevi with positive histologic margins may be an effective management option.

The study goal was to “address the knowledge gap identified in the Pigment Lesion Subcommittee consensus statement to help guide future management of moderately dysplastic nevi with positive histologic margins.”

The researchers investigated participants who underwent excisional biopsy without clinical residual pigment of a nevus over a 3-year minimal follow-up interval screening for cutaneous melanoma development. The investigators used a randomization technique wherein an independent site dermatopathologist reviewed 5 deidentified slides from each study site. 

The multisite (9 sites) study identified 438 participants with moderately dysplastic nevi (467 cases) with positive margins that met their inclusion criteria. The study population was 96.7% white and 55.9% male, and 33.2% of participants had a personal history of cutaneous melanoma. The mean age was 46.7 years (SD 16.1) with an age range of 18 to 85 years.

The investigators showed no cases of cutaneous melanoma occurred at biopsy site after a mean follow-up time of 6.9 years (SD 3.4), and 22.8% of the 467 cases developed a subsequent primary cutaneous melanoma at a separate site. The study showed age (older participants were more susceptible) and prior cutaneous melanoma as factors associated with the risk for development of a subsequent cutaneous melanoma at a separate site. The independent site dermatopathologist agreed that “35 of 40 of the study cases represented lesions within the spectrum of mildly to moderately dysplastic nevi or moderately dysplastic nevi.” The authors noted the study population size, retrospective study design, and patient inclusion/exclusion criteria as study limitations.

Taken together, these findings suggest that observation of moderately dysplastic nevi excisionally biopsied with positive histologic margins may be an effective management option.

Disclosures: Multiple authors declared associations with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.

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Reference

Kim CC, Berry EG, Marchetti MA, et al; for the Pigmented Lesion Subcommittee, Melanoma Prevention Working Group. Risk of subsequent cutaneous melanoma in moderately dysplastic nevi excisionally biopsied but with positive histologic margins [published online October 10, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.3359