title: Dysplastic (or Atypical) Nevi Showing Moderate or Severe Atypia With Clear Margins on the Shave Removal Specimens Are Most Likely Completely Excised.
abstract: BACKGROUND
  Dysplastic nevi (DN) are graded by their degree of atypia into 3 categories of mild, moderate, and severe. In many practices, DN with moderate or severe atypia are generally excised regardless of the status of the shave specimen margins.
  
  
  OBJECTIVE
  With a new approach toward the margins on the shave removal specimens (SRS), the goal herein is to assess whether the shave removal procedure can sufficiently remove DN with moderate or severe atypia.
  
  
  METHODS
  A total of 426 SRS diagnosed with DN showing moderate or severe atypia between January and December 2015 along with their post-shave excision specimens were reviewed. Based on the author's experience, clear or negative margins on the SRS were defined as neoplastic melanocytes confined within >0.2 mm of the lateral and deep specimen margins. The biopsy specimens were accompanied by Melan-A highlighting the subtle neoplastic cells.
  
  
  RESULTS
  With a negative predictive value (NPV) of 98.4% (confidence interval: 97.2% to 100%, P < .001), DN showing moderate or severe atypia with clear margins are most likely removed by the shave procedure.
  
  
  CONCLUSIONS
  Routine excision of DN showing moderate or severe atypia with clear margins on SRS is not necessary. Regular surveillance is sufficient.
authors.affiliation: 1 DermOne Dermatology Associates of New Jersey, Forked River, NJ, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Maghari
mesh_terms: D001706:Biopsy; D062109:Dermatologic Surgical Procedures; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D058965:MART-1 Antigen / Q000032:analysis; D000072662:Margins of Excision; D008853:Microscopy; D018365:Neoplasm, Residual; D009506:Nevus / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*
chemical_list: D058965:MART-1 Antigen
keywords: atypical nevi; atypical nevus; clear margin; clear margins; dysplastic nevi; dysplastic nevus; excision; margin; margins; negative margins