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Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins.

Publication ,  Journal Article
Kim, CC; Berry, EG; Marchetti, MA; Swetter, SM; Lim, G; Grossman, D; Curiel-Lewandrowski, C; Chu, EY; Ming, ME; Zhu, K; Brahmbhatt, M; Liu, Y ...
Published in: JAMA Dermatol
December 1, 2018

IMPORTANCE: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). OBJECTIVE: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. DESIGN, SETTING, AND PARTICIPANTS: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. MAIN OUTCOMES AND MEASURES: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. RESULTS: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P < .001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P = .01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. CONCLUSIONS AND RELEVANCE: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

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Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

December 1, 2018

Volume

154

Issue

12

Start / End Page

1401 / 1408

Location

United States

Related Subject Headings

  • Young Adult
  • Skin Neoplasms
  • Skin
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Melanoma, Cutaneous Malignant
  • Melanoma
  • Margins of Excision
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kim, C. C., Berry, E. G., Marchetti, M. A., Swetter, S. M., Lim, G., Grossman, D., … Pigmented Lesion Subcommittee, Melanoma Prevention Working Group, . (2018). Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol, 154(12), 1401–1408. https://doi.org/10.1001/jamadermatol.2018.3359
Kim, Caroline C., Elizabeth G. Berry, Michael A. Marchetti, Susan M. Swetter, Geoffrey Lim, Douglas Grossman, Clara Curiel-Lewandrowski, et al. “Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins.JAMA Dermatol 154, no. 12 (December 1, 2018): 1401–8. https://doi.org/10.1001/jamadermatol.2018.3359.
Kim CC, Berry EG, Marchetti MA, Swetter SM, Lim G, Grossman D, et al. Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol. 2018 Dec 1;154(12):1401–8.
Kim, Caroline C., et al. “Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins.JAMA Dermatol, vol. 154, no. 12, Dec. 2018, pp. 1401–08. Pubmed, doi:10.1001/jamadermatol.2018.3359.
Kim CC, Berry EG, Marchetti MA, Swetter SM, Lim G, Grossman D, Curiel-Lewandrowski C, Chu EY, Ming ME, Zhu K, Brahmbhatt M, Balakrishnan V, Davis MJ, Wolner Z, Fleming N, Ferris LK, Nguyen J, Trofymenko O, Liu Y, Chen SC, Pigmented Lesion Subcommittee, Melanoma Prevention Working Group. Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Histologic Margins. JAMA Dermatol. 2018 Dec 1;154(12):1401–1408.

Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

December 1, 2018

Volume

154

Issue

12

Start / End Page

1401 / 1408

Location

United States

Related Subject Headings

  • Young Adult
  • Skin Neoplasms
  • Skin
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Melanoma, Cutaneous Malignant
  • Melanoma
  • Margins of Excision
  • Male