MedicalResearch.com Interview with:
Caroline C. Kim, M.D.
Associate Professor, Department of Dermatology
Harvard Medical School
Director, Pigmented Lesion Clinic
Associate Director, Cutaneous Oncology Program
Beth Israel Deaconess Medical Center
Boston, MA 02215
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Atypical/dysplastic nevi have been identified as risk factors for melanoma, however the majority of melanomas arise as new lesions on the skin.
Unlike other models of dysplasia having a clear trajectory towards cancer as seen in cervical dysplasia, dysplastic nevi are not proven to be obligate precursors for melanoma. However, there is little evidence to guide the management of biopsied dysplastic nevi with positive margins, with much clinical variation in the management of moderately dysplastic nevi in particular.
In this multi-center national study of 9 U.S. academic centers, we examined outcomes of 467 moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins with at least 3 years of clinical follow-up. We found that no cases developed into a same-site melanoma with a mean follow-up time of 6.9 years. However, 22.8% of our patients went on to develop a future separate site melanoma.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that observation with routine skin surveillance is a reasonable approach for moderately dysplastic nevi excisionally biopsied with positive histologic margins. Having 2 more biopsied dysplastic nevi, one of which is moderately dysplastic was found to be associated with increased risk for subsequent cutaneous melanoma at a separate site. Our findings underscore that dysplastic nevi are not obligate precursors for melanoma, but rather, are phenotypic markers for patients at risk for melanoma.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: –Future, prospective research with larger numbers of cases would strengthen our conclusions.
Kim CC, Berry EG, Marchetti MA, et al. Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol. Published online October 10, 2018. doi:10.1001/jamadermatol.2018.3359
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