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- Presentation
Shared Decision Making for Management of Dysplastic Nevi: Markers of Risk Not Pre-Melanomas
Description
In this presentation, Dr. Elizabeth Berry discusses the complexities of managing dysplastic nevi and emphasizes the importance of shared decision-making in clinical practice. Highlighting her background and experiences, she recalls a pivotal patient with dysplastic nevus syndrome. Berry shares that dysplastic nevi possess unique histological features that differentiate them from normal nevi and that their grading can vary among dermatopathologists, introducing potential for uncertainty in diagnosis. She presents a decision tool developed by her team to aid in discussing risks and treatment options with patients. Through patient case studies, she illustrates how factors such as pretest probability, patient anxiety, pathology nuances, and clinical context inform treatment decisions. Berry stresses that dysplastic nevi are not inherent precursors to melanoma but serve as risk markers, emphasizing continuous monitoring and informed patient involvement in their care. She concludes by urging clinicians to approach the management of these lesions with care and collaboration, underscoring the art of patient-centered dermatology.
View moreConclusions
- Dysplastic nevi exhibit unique histologic features that differentiate them from common nevi.
- These nevi can be graded as mild, moderate, and severe based on specific criteria, although there can be variability among pathologists.
- Interpretation of dysplastic nevi is subjective, leading to variability in diagnosis among pathologists.
- The majority of dysplastic nevi are not considered pre-malignant lesions, meaning they do not necessarily lead to melanoma.
- Only a small percentage of dysplastic nevi may progress to melanoma, and the risk is generally low.
- In cases with positive margins, there is a concern for residual neoplastic cells, which could necessitate further treatment.
- Shared decision-making between patients and physicians is crucial in determining the management of dysplastic nevi based on individual risk factors and patient preferences.
- Patients should be informed about the potential risks of monitoring versus surgical excision when managing atypical nevi.
- A patient decision aid tool has been developed to facilitate discussions about treatment options for dysplastic nevi.
- Elmore JG, Barnhill RL, Elder DE, Longton GM, Pepe MS, Reisch LM, Carney PA, Titus LJ, Nelson HD, Onega T, Tosteson AN. BMJ. 2017 Jun 28;357:j2813.
- 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.
- Kim CC, et al. JAMA Dermatology. 2015