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No increased risk of melanoma at removal site of dysplastic nevi

Clinical Question:
Are patients with an incompletely or narrowly removed dysplastic nevus at an increased risk for development of melanoma at the removal site?

Bottom Line:
This study found no increased risk of melanoma development at the original excision site or of metastatic melanoma in patients with an incompletely or narrowly removed (extending to within 0.2 mm of a microscopic border) histologically dysplastic nevus. However, only 7 of the total 115 cases included patients with severely dysplastic nevi and only 3 of these were followed up for more than 20 years. Additional studies are needed with a larger sample size to confirm these findings. (LOE = 1b-)

Reference:
Hocker TL, Alikhan A, Comfere NI, Peters MS. Favorable long-term outcomes in patients with histologically dysplastic nevi that approach a specimen border. J Am Acad Dermatology 2013;68(4):545-551.  [PMID:23127472]

Study Design:
Cohort (retrospective)

Funding:
Self-funded or unfunded

Setting:
Outpatient (specialty)

Synopsis:
Although patients with dysplastic nevi are at an increased risk of melanoma, the risk of melanoma arising at the site of a previous incompletely or narrowly removed dysplastic nevus is uncertain. These investigators identified patients (n = 115) who had a histologically dysplastic nevus removed from January 1, 1980, through December 31, 1989, that extended to within 0.2 mm of a microscopic border and was not re-excised. Specimens were obtained via punch, shave, or excisional biopsy. Final histologic classification occurred by consensus of 2 certified dermatopathologists using established criteria. The average follow-up for the 115 eligible patients was 17.4 years, with long-term follow-up occurring for 71.3% of patients at 10 years, 67.8% at 15 years, and 63.4% at 20 years or more. More than 20 years of follow-up occurred for 64% of patients (42 of 66) with mildly dysplastic nevi, 64% (27 of 42) with moderately dysplastic nevi, and 43% (3 of 7) with severely dysplastic nevi. No cases of melanoma arising in the original site of excision or of metastatic melanoma developed during the follow-up period.

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