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Multicenter Study
. 2018 Dec 1;154(12):1401-1408.
doi: 10.1001/jamadermatol.2018.3359.

Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins

Caroline C Kim  1 , Elizabeth G Berry  2   3 , Michael A Marchetti  4 , Susan M Swetter  5   6 , Geoffrey Lim  7 , Douglas Grossman  8   9 , Clara Curiel-Lewandrowski  10 , Emily Y Chu  11 , Michael E Ming  11 , Kathleen Zhu  12 , Meera Brahmbhatt  2   13 , Vijay Balakrishnan  2   3 , Michael J Davis  2   3 , Zachary Wolner  4 , Nathaniel Fleming  5   6 , Laura K Ferris  7 , John Nguyen  14 , Oleksandr Trofymenko  10 , Yuan Liu  2 , Suephy C Chen  2   3 ; Pigmented Lesion Subcommittee, Melanoma Prevention Working Group
Affiliations
Multicenter Study

Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins

Caroline C Kim et al. JAMA Dermatol. .

Abstract

Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins).

Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more.

Design, setting, and participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018.

Main outcomes and measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins.

Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P < .001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P = .01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up.

Conclusions and relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kim reported serving as an investigator for Hoffmann-La Roche Inc. Dr Grossman reported serving as an investigator for Orlucent Inc. Dr Curiel-Lewandrowski reported serving as an Investigator for Amgen and consultant for Novartis. Dr Ferris reported serving as a consultant for DermTech International and an investigator for Castle Biosciences. Dr Chen reported serving as a consultant for Leo Pharma US, receiving grants from the National Eczema Association, and receiving royalties from the licensing of ItchyQoL (Procter & Gamble, Regeneron Pharmaceuticals Inc) and RosaQoL (Novartis, Intendis Inc). No other disclosures were reported.

Comment in

References

    1. Duffy KL, Mann DJ, Petronic-Rosic V, Shea CR. Clinical decision making based on histopathologic grading and margin status of dysplastic nevi. Arch Dermatol. 2012;148(2):259-260. doi:10.1001/archdermatol.2011.2045 - DOI - PubMed
    1. Tong LX, Wu PA, Kim CC. Degree of clinical concern and dysplasia affect biopsy technique and management of dysplastic nevi with positive biopsy margins: Results from a survey of New England dermatologists. J Am Acad Dermatol. 2016;74(2):389-91.e1, 2. doi:10.1016/j.jaad.2015.09.055 - DOI - PubMed
    1. Nelson KC, Grossman D, Kim CC, et al. . Management strategies of academic pigmented lesion clinic directors in the United States. J Am Acad Dermatol. 2018;79(2):367-369. doi:10.1016/j.jaad.2017.12.069 - DOI - PubMed
    1. Kim CC, Swetter SM, Curiel-Lewandrowski C, et al. . Addressing the knowledge gap in clinical recommendations for management and complete excision of clinically atypical nevi/dysplastic nevi: Pigmented Lesion Subcommittee consensus statement. JAMA Dermatol. 2015;151(2):212-218. doi:10.1001/jamadermatol.2014.2694 - DOI - PubMed
    1. Fleming NH, Egbert BM, Kim J, Swetter SM. Reexamining the threshold for reexcision of histologically transected dysplastic nevi. JAMA Dermatol. 2016;152(12):1327-1334. doi:10.1001/jamadermatol.2016.2869 - DOI - PubMed

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