COMMENTARY

Dysplastic Nevi: Monitoring and Management

Graeme M. Lipper, MD

Disclosures

October 25, 2018

Viewpoint

This study of moderately dysplastic nevi with positive histologic margins is consistent with previous smaller studies[8,9] and supports the practice of monitoring such biopsy sites without re-excision. During an average follow-up of 6 years, no cutaneous melanomas were observed. They also confirmed dysplastic nevi as an independent risk factor for cutaneous melanoma, which has been well documented elsewhere. These observations were specific to an almost exclusively white study population.

One clinical consideration that was not addressed is what to do when repigmentation does occur within or near the scar of a previously biopsied dysplastic nevus. Should the recurrent pigmentation be re-excised? Does it make any difference whether the repigmentation occurs within the biopsy scar or extends beyond its clinical borders? What percentage of these recurrent pigmented lesions are dysplastic nevi with the same or higher grade dysplasia?

Finally, most biopsied dysplastic nevi (69.5%) in this retrospective cohort were truncal, raising the remote possibility that dysplatic nevi removed from other cutaneous sites (eg, acral, face, genital) with positive margins may pose a greater future malignant melanoma risk.

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