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Biopsy Margin for Total Removal of Dysplastic Nevi
Complete removal of individual dysplastic nevi is often achieved by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by the histopathologic margins of the initial biopsy specimen.
A study recently published in the Journal of the American Academy of Dermatology evaluated the clinical and histopathologic outcomes of total biopsy of dysplastic nevi using a pre-determined margin of normal skin.
Researchers conducted a prospective study of a saucerisation method using a defined 2mm margin in patients undergoing biopsy of a pigmented skin lesion.
One hundred and fifty-one biopsies were performed in 138 patients. Overall, 137 of 151 (90.7 per cent) of lesions subjected to biopsy were melanocytic: 86 dysplastic nevi (57 percent), 40 nevi without atypia (26.5 per cent), and 11 melanomas (7.3 per cent).
Of 78 dysplastic nevi, 68 (87.2 per cent) were removed with clear histopathological margins. There was no evidence of recurrence at any of the biopsy sites that were simply observed (that is, not re-excised) over an average of 16.9 months.
The study concluded that complete histopathological removal of nearly 90 per cent of dysplastic nevi using a peripheral margin of 2mm of normal skin and a depth at the dermis and subcutaneous fat junction has the potential to decrease second procedures at dysplastic nevi biopsy sites, thereby decreasing patient morbidity and saving health care dollars.
Terushkin, V. et al. (December 2017.) A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi. Journal of the American Academy of Dermatology. Volume 77, Issue 6, Pages 1096–1099. DOI: http://dx.doi.org/10.1016/j.jaad.2017.07.016