MedicalResearch.com Interview with:
Susan M. Swetter, MD
Professor of Dermatology
Director, Pigmented Lesion & Melanoma Program
Physician Leader, Cancer Care Program in Cutaneous Oncology
Stanford University Medical Center and Cancer Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Dysplastic nevi (DN) are frequently re-excised following initial biopsy due to concerns for malignant transformation; however, the long-term risk of melanoma developing in mildly or moderately dysplastic nevi with positive histologic margins is unknown. In this cohort study of 590 histologic DN that were followed over 20 years, 6 cases of melanoma (5 in situ) arose in the 304 DN with positive margins that were clinically observed, only 1 of which developed from an excisionally-biopsied dysplastic nevus. One melanoma in situ arose in the 170 cases that underwent complete excision at the outset. The risk of new primary melanoma at other sites of the body was over 9% in both groups.
MedicalResearch.com: What should readers take away from your report?
Response: Partial biopsy of a concerning nevus should be discouraged, as sampling error may result in a later diagnosis of melanoma. Mildly to moderately dysplastic nevi that are biopsied with excisional intent but show histologically involved margins can generally be clinically monitored without re-excision. Melanoma risk at other sites of the body remains elevated in the patients with DN.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: These findings add to recent data suggesting that re-excision of mild to moderate DN is generally not warranted in the absence of severe dysplasia or a non-representative biopsy. Additional analysis of larger numbers of cases will help to clarify the risks and most appropriate management for incompletely-excised DN.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study supports that the threshold for re-excision of mildly to moderately dysplastic nevi can be raised.
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