Do Dysplastic Moles Need To Be Re-Excised? Interview with:
Timothy Patton, DO

Department of Dermatology
Falk Medical Center
University of Pittsburgh Medical Center What is the background for this study? What are the main findings?

Response: As dermatologists we are confronted daily with how to manage lesions that are biopsied and diagnosed as dysplastic nevi. These lesions are considered by some to be potential melanoma precursors and by others as benign lesions with little to no malignant potential. Often, particularly for lesions with severe atypia these lesions are re excised. There are no prospective studies or consistent guidelines as to how to manage these lesions. We decided to retrospectively look at the outcome of 451 patients with dysplastic nevi with severe atypia, many of whom had not had their lesions re-excised, who had at least 5 years of follow up to determine if any developed melanoma at the site of the biopsied dysplastic nevus or distantly. We found no cases of metastatic melanoma in patients who did not already have a diagnosis of melanoma. We found two cases of thin melanoma in patients who had their lesions re-excised. Both of those patients were treated with reexcision and did not develop subsequent melanoma metastasis or recurrence. What should readers take away from your report?

Response: The risk posed by dysplastic nevi, even if there is severe atypia, is likely low given our findings in these patients. Our data do not suggest that failure to re-excise dysplastic nevi, even with positive margins, carries a risk of subsequent metastatic melanoma. It is also important to consider the prior history of the patient, such as history of melanoma, and whether the lesion was sampled by a partial biopsy, in which case histology may not be representative of the entire lesion. What recommendations do you have for future research as a result of this study?

Response: In the future, a prospective study would be useful to try to determine which lesions can be treated with clinical observation and which lesions should be re-excised. Determining this could impact the rate of re-excision of dysplastic nevi with severe atypia, which is important in terms of health-care costs and the surgical risks of infection and scar. Is there anything else you would like to add?

Response: There are some limitations to our study and as such the current practices of dermatologists when it comes to how to handle dysplastic nevi with severe atypia might not change much because of this report. When margins are positive, we think that most dermatologists will still perform re-excision, which still seems reasonable given what we know at this point. When there are free margins on biopsy, unless there are additional histologic or clinical features that are concerning, clinical observation seems like a reasonable approach. We feel that are paper provides good evidence for that practice. Thank you for your contribution to the community.


Dysplastic nevi with severe atypia: Long-term outcomes in patients with and without re-excision
Engeln, Kathleen et al.
Journal of the American Academy of Dermatology , Volume 0 , Issue 0 ,
Published online:November 09, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on

[wysija_form id=”5″]

Last Updated on November 14, 2016 by Marie Benz MD FAAD