Otro comentario sobre el mismo articulo del seguimiento de nevus displásicos.
Observation May Be Acceptable for Moderately Dysplastic Nevi With Positive Margins
NEW YORK (Reuters Health) - Routine skin surveillance is a "reasonable" approach to managing moderately dysplastic nevi with positive histologic margins, although patients with two or more such nevi are at increased risk of developing cutaneous melanoma at a different site, researchers say.
"Dysplastic nevi/clinically atypical nevi (moles) have been identified as risk factors for melanoma; however, the majority of melanomas arise as new lesions on the skin," Dr. Caroline Lee of Beth Israel Deaconess Medical Center in Boston told Reuters Health by email.
"Unlike other models of dysplasia having a clear trajectory towards cancer, as seen in cervical dysplasia," she said, "dysplastic nevi are not proven to be obligate precursors for melanoma."
"There is little evidence to guide the management of biopsied dysplastic nevi with positive margins," she noted, "with much clinical variation in the care of moderately dysplastic nevi in particular."
To investigate, Dr. Lee and colleagues studied 438 patients (mean age 46.7; 55.9% men) with 467 moderately dysplastic lesions at nine U.S. academic dermatology sites. Patients were followed for a mean of 6.9 years.
As reported online October 10 in JAMA Dermatology, no patient developed cutaneous melanoma at a biopsy site, but 100 (22.8%) developed a cutaneous melanoma at a different site.
The risk of developing a cutaneous melanoma at a separate site was significantly associated with a history of cutaneous melanoma (odds ratio, 11.74) and with previously biopsied dysplastic nevi (OR, 2.55).
A central dermatopathologic review of 40 random representative case slides showed agreement in 35 of the cases (87.5%).
Of the remaining cases, two (5%) were interpreted as mildly dysplastic nevi and two as moderately to severely dysplastic nevi.
One case was interpreted as melanoma in situ. A review of the case with the host site revealed that the patient had not had a clinical recurrence at the biopsy site after five years of follow-up
Dr. Lee affirmed, "Our findings underscore that dysplastic nevi are not obligate precursors for melanoma, but rather, are phenotypic markers for patients at risk for melanoma."
Dr. Kelly Nelson of The University of Texas MD Anderson Cancer Center in Houston, coauthor of a related editorial, told Reuters Health the study "represents a significant multi-institutional collaborative effort to add to the paucity of dysplastic nevi management literature."
"In caring for my patients, I make every attempt to remove lesions concerning for melanoma in their clinical entirety with a small margin of normal skin," she said by email. "When the scenario arises of a dysplastic nevus with moderate atypia and microscopically positive margins on histopathologic review, and the interpretation by our . . . dermatopathologists aligns with my clinical impression, I am very comfortable monitoring the site for longitudinal clinical recurrence."
"In the setting of high patient anxiety, or when my clinical concern for the lesion is discordant from the dermatopathology interpretation, we proceed with a conservative therapeutic excision," Dr. Nelson concluded.
SOURCE: http://bit.ly/2CtgSdf and http://bit.ly/2Cs0jP8
JAMA Dermatol 2018.
Reuters Health Information © 2018
Cite this article: Observation May Be Acceptable for Moderately Dysplastic Nevi With Positive Margins - Medscape - Oct 19, 2018.
posted by dermatica at
October 30, 2018
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