Recurrence, Progression to Melanoma, and Patterns of Management in Patients With Nevi of Special Sites

Written by

 

 

Ashfaq A. Marghoob MD

The bottom line:

• This article highlights that the clinical/histopathology morphology of special site nevi has no correlation with the biology (risk of recurrence or malignant transformation) of the lesion.
• Special site nevi may appear atypical (morphology), but they do not behave in an atypical manner (biology).
• The authors state that dermoscopy may help but that H&E remains the gold standard. This is an interesting comment, given that their gold standard had only fair agreement. The gold standard is not morphology but rather the biology of the lesion!

TAKE-HOME MESSAGE

• In this single-center cohort study, recurrence and melanoma transformation rates of nevi of special sites (NOSS) were investigated. The recurrence rate was 1.46%, with no cases progressing to melanoma. Additionally, a dermatopathology panel performed a blinded re-examination of the original biopsy slides. Only a fair concordance was found between original treatment recommendations and panel consensus recommendations.
• Clinical monitoring appears to be a safe management option for NOSS, given their limited potential for malignant transformation. Further research may help elucidate high-risk histopathologic features of NOSS.

–  Ruth McTighe, MD

Abstract 

Nevi of specialized sites (NOSS) occur on the scalp, ears, flexural, acral, and genital areas and display atypical clinical and histologic features. We assessed NOSS recurrence and progression to melanoma, management patterns, and associations between histologic features and treatment recommendations. We queried all histologic diagnoses of NOSS (n = 275) from 2012 to 2017 from a large U.S. academic medical center with reference dermatopathology laboratory and matched these to clinical records. A blinded panel of dermatopathologists re-evaluated lesions, catalogued histologic findings, and gave management recommendation. Associations with dermatopathologist decision and concordance between new and original recommendations were assessed. Of 117 cases with follow-up, 2 locally recurred (1.46%) and none eventuated in melanoma. Clinical features were not associated with original treatment recommendations. After histopathologic review, large melanocytes [odds ratio ratio (ORR) = 8.00, 95% CI, 1.35-47.4] and junctional mitotic figures (ORR = 65.0, 6.5-650) predicted excision recommendation. Likewise, accumulation of many (>9) high-risk features was associated with excision recommendation. Panel review changed treatment recommendation in 27% of cases. Fair concordance existed between original and panel recommendations (κ = 0.29, 0.15-0.44). The low rate of recurrence and lack of melanoma occurrence suggest that despite an atypical clinical and histopathologic appearance, these nevi have limited potential for malignant transformation. Histopathologic findings seem to be principal drivers behind the recommendation for excision in this analysis. Variability existed in treatment recommendations; the panel's consensus recommendation tended to downgrade treatment. This highlights the importance of further outcomes-based studies to identify true high-risk features and refine management guidelines.

The American Journal of Dermatopathology

A Single-Institution Cohort Study With Nevi of Special Site: Recurrence, Progression to Melanoma, and Patterns of Management

Am J Dermatopathol 2023 Jan 01;45(1)28-39, DM Elkeeb, ZH Hopkins, CM Bolender, C Moreno, SR Florell, AR Bowen, P Vitale, J Zussman, K Duffy, D Grossman, AM Secrest, DA Wada 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.