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[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.
So, as we have said before:
- 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.
- 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.
- If the lesion is reported as severe dysplasia, I recommend complete excision.
Professor David Wilkinson
Read more from Professor David Wilkinson on recent research:
- Managing Spitz lesions in children
- Managing patient anxiety while undergoing skin cancer excision
- Managing subungual melanoma in situ in general practice
- Diagnostic accuracy for skin cancer among non-doctors
- Dermoscopy in the diagnosis of melanoma in situ