title: The utility of re-excising mildly and moderately dysplastic nevi: a retrospective analysis.
abstract: BACKGROUND
  The management of dysplastic nevi (DN) is a highly debated and controversial topic within the dermatology community. Clinicians agree that margin-positive severely DN should be removed with a surgical margin, however, there is disagreement surrounding the appropriate management of margin-positive mildly and moderately DN.
  
  
  OBJECTIVE
  We sought to evaluate the utility of re-excising margin-positive mildly and moderately DN.
  
  
  METHODS
  A retrospective chart review was conducted on all adult patients given the diagnosis of a biopsy-proven DN from 2010 through 2011. The primary outcomes were defined as the presence of melanocytic residuum in re-excisional specimens and a clinically significant change in diagnosis.
  
  
  RESULTS
  A total of 1809 mildly and moderately DN were diagnosed from 2010 through 2011. In all, 765 (42.3%) of these lesions were found to have positive surgical margins during biopsy, and 495 (64.7) of the 765 lesions were subsequently re-excised. Melanocytic residuum was present in 18.2% of re-excisional specimens. Re-excision resulted in a clinically significant alteration of the diagnosis in only 1 case (0.2%).
  
  
  CONCLUSIONS
  Limitations include retrospective design and inability to assess for malignant transformation given limited follow-up.
  
  
  CONCLUSIONS
  Re-excising mildly and moderately DN results in a low histopathological yield and rarely results in a clinically significant change in diagnosis. As such, clinical monitoring of margin-positive lesions may be warranted.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Strazzula
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Vedak
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Mai P
authors.initials: MP
authors.lastname: Hoang
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Arthur
authors.initials: A
authors.lastname: Sober
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Hensin
authors.initials: H
authors.lastname: Tsao
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dkroshinsky@mgh.harvard.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Kroshinsky
mesh_terms: D000328:Adult; D001706:Biopsy; D004416:Dysplastic Nevus Syndrome / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008545:Melanoma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery
keywords: dermatopathology; dysplastic nevus; melanoma; nevus; pigmented lesions; surgical management