Kathleen Engeln1, Kaitlin Peters2, Jonhan Ho3, Jaroslaw Jedrych3, Daniel Winger4, Laura Korb Ferris2, Timothy Patton5. 1. Scripps Mercy Hospital, Pittsburgh, Pennsylvania. 2. Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Department of Dermatopathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Clinical and Translational Science Institute, Pittsburgh, Pennsylvania. 5. Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: patttj@upmc.edu.
Abstract
BACKGROUND: Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited. OBJECTIVE: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. METHODS: A retrospective single institutional study was conducted with 451 adult patients (mean age 41.3 years) with SDN biopsied between November 1994 and November 2004, with clinical follow-up of at least 5 years. RESULTS: In 451 patients with SDN, re-excision was performed on 36.6%. Two melanomas were diagnosed in the re-excision specimens. Subsequent metastatic melanoma developed in 7 patients, all of whom had a history of melanoma. Margin comments influenced decision to re-excise. LIMITATIONS: This was a retrospective study at a single institution. CONCLUSION: Re-excision of all SDN may not be necessary.
BACKGROUND:Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited. OBJECTIVE: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. METHODS: A retrospective single institutional study was conducted with 451 adult patients (mean age 41.3 years) with SDN biopsied between November 1994 and November 2004, with clinical follow-up of at least 5 years. RESULTS: In 451 patients with SDN, re-excision was performed on 36.6%. Two melanomas were diagnosed in the re-excision specimens. Subsequent metastatic melanoma developed in 7 patients, all of whom had a history of melanoma. Margin comments influenced decision to re-excise. LIMITATIONS: This was a retrospective study at a single institution. CONCLUSION: Re-excision of all SDN may not be necessary.
Authors: Mustufa A Jafry; Sue Peacock; Andrea C Radick; Hannah L Shucard; Lisa M Reisch; Michael W Piepkorn; Stevan R Knezevich; Martin A Weinstock; Raymond L Barnhill; David E Elder; Kathleen F Kerr; Joann G Elmore Journal: J Am Acad Dermatol Date: 2019-12-17 Impact factor: 11.527