How to Manage Clinically Atypical Nevi/Dysplastic Nevi: A New Consensus Statement
Though a National Institutes of Health consensus statement on the management of clinically atypical nevi/dysplastic nevi (CAN/DN) has existed for over 20 years, there is significant variability and controversy around clinical management. When histologically positive margins are encountered, health care providers must decide whether to recommend reexcision or observation alone. The Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) recently developed recommendations for clinical management for DN with positive histologic margins by based on the current evidence.
The PLS reviewed the literature from 1975 to 2014 for articles related to CAN and the biopsy and excision of DN with particular focus on 5 recent studies pertaining to the management and outcomes of DN with positive margins. Some key issues examined were biopsies of CAN and how positive margins arise, whether incompletely excised DN evolve into melanoma, and current data on the outcomes of DN with positive histologic margins. The members of the PLS/MPWG agreed on management guidelines while also highlighting critical knowledge gaps in management for DN with positive histologic margins. The group developed 9 recommendations, most notably: that (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 a definitive recommendation.
In the statement, published in JAMA Dermatology, the authors point out knowledge gaps and propose that a future large-scale study would help guide the management of DN with positive margins.
Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH
Adapted from the original article.
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