[3 min read] The problem of dysplastic naevi

We all continue to be plagued by the problem of dysplastic naevi, and especially what to do if we biopsy these lesions and the pathology report comes back with “margins involved”. What should we do?

A new paper by Adamson is an editorial on a paper by Kim et al. Kim and colleagues follow up patients with moderately dysplastic naevi who had these lesions excised completely (by clinical view) but whose margins were reported as involved histologically.

A total of 467 naevi were followed for an average of seven years. There were no cases of biopsy site melanomas on follow up. However, 25 per cent of patients developed a melanoma at another cutaneous site.

What this study supports is that dysplastic naevi are not a precursor for melanoma. They are, however, a marker for melanoma risk.

Read the paper here.

So, as we have said before:

  1. If you biopsy a dysplastic naevus, you should do so by complete, excision biopsy – make sure that to your naked eye, you excise the whole lesion.
  2. If the margins are reported as involved on pathology, you can safely follow up with no further excision – if the lesion is reported as mild or moderate dysplasia.
  3. If the lesion is reported as severe dysplasia, I recommend complete excision.

Professor David Wilkinson

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2 comments on “[3 min read] The problem of dysplastic naevi

  1. It is now well-recognised that the term ‘dysplastic naevus’ should not be used. The late Bernie Ackerman published a paper on this not long before his death (alas, I do not have the reference now), in which he points out that this kind of lesion was first described in 1971 and has gone under no fewer than 31 names since.
    As a rule of thumb, a mildly atypical naevus should be called just that, and no more needs to be done. Avoid the word dysplasia, as that has cellular connotations. It may well be a marker for future melanoma development elsewhere, but ‘dysplasia’ itself is no marker. We all know that a ‘severely dysplastic naevus’ should REALLY have been reported as a melanoma, and therefore it needs to be treated as such: it IS a melanoma.
    Where I get really peeved is when the histo comes back as ‘moderately dysplastic naevus’. It is fence-sitting by the pathologist, and may well lead to undertreatment, and kill patients.

  2. Agreed Hein. Only disagreement is that we don’t “all” know this – most GPs don’t and continue to be confused by this language. Language that should not be used