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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
Key Questions Posed by the Organizers
“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”
Management of "Dysplastic Nevi"
1983 NIH Consensus Development Conference:
"The formulation of an effective management strategy for patients with dysplastic nevi depends upon their classification in one of two groups:
1. Dysplastic nevi with a family history of melanoma.
2. Dysplastic nevi without a family history of melanoma. . . .
In patients with dysplastic nevi and any family history of melanoma, the indication for excising additional dysplastic nevi is the suspicion of early melanoma. In such lesions, the decision will be influenced by variation in color, size of the lesion relative to the patient's other nevi, or progressions. Follow-up should be conducted every 3 to 6 months."
1992 NIH Consensus Development Conference: "Lesions that develop de novo may be monitored for 6 months to 1 year, but biopsy specimens should be obtained from them if there is a suspicion of melanoma or rapid changes occur. To permit adequate diagnosis, the biopsy should be a total removal by punch, saucerization, or elliptical excision to include a portion of underlying subcutaneous fat. . . . In providing the histological interpretation of a nevus with architectural disorder with varying degrees of melanocytic atypia, the pathologist should note whether the margins of the specimen are involved by the process. If re-excision is indicated, margins of 0.2 to 0.5 cm are appropriate."
If a pigmented lesion is thought to be a melanoma, it should be biopsied, and if it is not suspected of being a melanoma, it need not be biopsied. In short, a DN identified clinically as a nevus, irrespective of whether or not it is encountered in a setting of a family history of melanoma, does not warrant biopsy; it may be presumed to be benign. Re-excision of any proliferation of melanocytes is indicated only if a histopathologist is uncertain about whether a particular proliferation is that of a nevus or a melanoma; the principle then in regard to margins should be complete removal of the lesion, rather than obeisance to arbitrary numbers of millimeters or centimeters that shrink further every decade.
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