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< Current issue
Dermatopathology: Practical & Conceptual October - December 1996
>
Dysplastic Nevus:: National Institutes of Health Consensus Development Conferences, 1983 and 1992— Consensus?
Daniela Massi, MD
Timothy A. Nielsen, MD
A. Bernard Ackerman, MD
Introduction
Title
Key Questions Posed by the Organizers
Recommended Terminology
“Dysplastic Nevus”: Clinical Aspects
“Dysplastic Nevus”: Histopathologic Aspects
“Dysplastic Nevus”: Cytologic Atypia
Prevalence of “Dysplastic Nevi”
“Dysplastic Nevus Syndrome”
Risk of Melanoma
Management of “Dysplastic Nevi”
Summary
References
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Key Questions Posed by the Organizers
1983 NIH Consensus Development Conference:
"1. Can dysplastic nevi and congenital nevi be defined clinically and histologically?
2. Are these nevi precursors to melanoma? What are the prevalence, natural history, and determinants of these precursors?
3. What is appropriate management of patients with dysplastic nevi and congenital nevi regarding: diagnosis, treatment, follow-up, familial screening, and education?
4. What directions should be taken for future research on precursor lesions to melanoma?"
1992 NIH Consensus Development Conference:
"1. What are the clinical and histological characteristics of early melanoma?
2. What is the appropriate management of patients with early melanoma regarding its diagnosis and treatment?
3. After treatment of early melanoma, should patients and family members be 'followed up'? Why and how?
4. Do dysplastic nevi exist, and what is their significance?
5. What is the role of education and screening in preventing morbidity and mortality due to melanoma?
6. What are the future directions for research, including primary prevention?"
Critique:
In 1983, a key question was "Can dysplastic and congenital nevi be defined clinically and histopathologically?" and in 1992 a crucial question was "Do dysplastic nevi exist and what is their significance?. If the answer to the second question is "No, they do not exist" then no significance can be accorded them. But nevi termed dysplastic under discussion at those conferences and in this article surely do exist, yet a question that has still to be answered in a consistent, comprehensible way about them is "What qualifies a DN as dysplastic, clinically and histopathologically?". In other words, "What are the criteria for diagnosis morphologically of DN?"
View Figure
View Figure
Figs. 2AB Panelists and speakers at the Consensus Development Conference at the National Institutes of Health in 1984.
View Figure
Fig. 3 Title page of written statement published in JAMA, 1992.
View Figure
Fig. 4 Panelists and speakers at the Consensus Development Conference at the National Institutes of Health in 1992
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