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Consensus Statement |

Addressing the Knowledge Gap in Clinical Recommendations for Management and Complete Excision of Clinically Atypical Nevi/Dysplastic Nevi Pigmented Lesion Subcommittee Consensus Statement

Caroline C. Kim, MD1; Susan M. Swetter, MD2,3; Clara Curiel-Lewandrowski, MD4; James M. Grichnik, MD, PhD5; Douglas Grossman, MD, PhD6; Allan C. Halpern, MD7; John M. Kirkwood, MD8; Sancy A. Leachman, MD, PhD9; Ashfaq A. Marghoob, MD7; Michael E. Ming, MD, MSCE10; Kelly C. Nelson, MD11; Emir Veledar, PhD12; Suraj S. Venna, MD13; Suephy C. Chen, MD, MS14,15
[+] Author Affiliations
1Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California
3Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
4Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, Division of Dermatology, Department of Medicine, University of Arizona, Tucson
5Melanoma Program, Department of Dermatology, Miller School of Medicine, University of Miami, Miami, Florida
6Pigmented Lesion Clinic, Departments of Dermatology and Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
7Pigmented Lesion Clinic, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
8Melanoma Program, University of Pittsburgh Cancer Institute, Department of Medicine, Dermatology and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania
9Melanoma and Cutaneous Oncology Program, Department of Dermatology, Oregon Health and Science University, Portland
10Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, Philadelphia
11Pigmented Lesion Clinic, Department of Dermatology, Duke University Medical Center, Durham, North Carolina
12Center for Research and Grants, Baptist Health South Florida, Miami
13Skin Oncology and Melanoma Center, Department of Medicine, MedStar Washington Cancer Institute and Georgetown University Medical Center, Washington, DC
14Melanoma and Pigmented Lesion Clinic, Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
15Division of Dermatology, Atlanta Veterans Administration Medical Center, Decatur, Georgia
JAMA Dermatol. 2015;151(2):212-218. doi:10.1001/jamadermatol.2014.2694.
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Importance  The management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence.

Objectives  To outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how positive margins arise, (2) whether incompletely excised DN evolve into melanoma, (3) current data on the outcomes of DN with positive histologic margins, (4) consensus recommendations, and (5) a proposal for future studies, including a large-scale study to help guide the management of DN with positive margins.

Evidence Review  The literature, including recent studies examining management and outcomes of DN with positive margins between 2009 to 2014, was reviewed.

Findings  A consensus statement by the PLS of the MPWG following review of the literature, group discussions, and a structured Delphi method consensus.

Conclusions and Relevance  This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.

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