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- Presentation
Challenges in Diagnosis and Management of Dysplastic Nevi
Description
The discussion focuses on the complexities surrounding the diagnosis and management of dysplastic nevi, highlighting three main challenges: the unknown malignant potential, the subjective nature of microscopic classification, and the variability in treatment approaches. Dysplastic nevi do not follow the typical progression to cancer seen in other organs, which complicates risk assessment in patients. A significant study showed variability among pathologists interpreting melanocytic lesions, leading to inconsistent classifications and management decisions. Survey data reveals differing opinions among specialists about the need for re-excision versus observation of mildly to moderately dysplastic nevi. Research indicates that patients with dysplastic nevi carry an increased risk of melanoma, but current guidelines suggest monitored observation rather than aggressive surgical approaches for nevi classified as mildly dysplastic with negative margins. Case discussions illustrate the necessity of considering patient history and features of nevi when determining management strategies, emphasizing the importance of shared decision-making and clear communication between providers and patients. In conclusion, while dysplastic nevi serve as risk markers rather than direct precursors to melanoma, careful monitoring and judicious excision strategies remain key in patient management.
View moreConclusions
- Dysplastic nevi's malignant potential is uncertain, complicating diagnosis and management.
- Dysplastic nevi do not show a consistent progression to melanoma, unlike dysplastic lesions in other organ systems.
- Histopathologic classification of dysplastic nevi is subjective and varies among pathologists, leading to inconsistent diagnoses.
- There is substantial variability in the management of dysplastic nevi due to a lack of standardized guidelines and insufficient outcome data.
- Close observation and routine skin surveillance are advisable for mild and moderate dysplastic nevi, regardless of margin status.
- Moderately dysplastic nevi with negative margins can be safely monitored, while those with positive margins may require excision based on individual patient factors.
- Patients with two or more dysplastic nevi, at least one of which is moderately dysplastic, are at greater risk for melanoma at separate sites, warranting close monitoring.
- Individuals with severe dysplastic nevi may require excisional biopsy, but recent studies suggest narrower margins could be adequate for re-excision.
- Pre-biopsy clinical suspicion and the ability to monitor patients are critical factors in managing dysplastic nevi.
- Adamson and Nelson 2018
- Elmore et al 2017
- Duffy 2012
- Tong 2016
- Nelson 2018
- Tessiatore 2019
- Brownstone 2022
- Vuong 2018
- Reddy 2013
- Fleming 2016
- Engeln 2017
- Kim CC et al., JAMA Dermatology. 2015
- Kim CC, Berry EG, Marchetti MA; JAAD. 2019 Jan 1;80(1):278-80
- Roland-McGowan JN, Freeman SC, et al. Development of a treatment decision aid for patients with dysplastic nevi who are candidates for re-excision. JAAD. 2025 PMID: 39827941.