Kmetz Emily C, Sanders Holly, Fisher Galen, Lang Pearon G, Maize John C
Department of Dermatology, Medical University of South Carolina, Charleston, SC 29425, USA.
South Med J. 2009 Jan;102(1):45-8. doi: 10.1097/SMJ.0b013e3181904289.
The definition and management of the atypical nevus remains a controversial issue. Some believe that atypical nevi are common variants of benign melanocytic nevi while others believe they are lesions intermediate between benign melanocytic nevi and melanoma. Therefore, the question of whether or not partially removed atypical nevi should be re-excised with clear margins in order to prevent their evolution into melanoma remains unanswered. Although studies have shown that most atypical nevi will never progress into melanoma, re-excision, when biopsy margins are positive, is commonly practiced. We argue that re-excision in such cases is not necessary.
Our cohort study includes 55 previously biopsied atypical nevi that were not re-excised and which were followed for at least 5 years with a mean follow up time of 6.12 years.
The experimental group included 26 atypical nevi whose biopsy revealed at least one involved margin. The control group included 29 atypical nevi whose biopsy revealed clear margins. No melanomas were observed to arise in association with a pre-existing atypical nevus in either the experimental or control group during the follow-up period.
The results of our study support observation as a safe alternative to re-excision for incompletely removed atypical nevi. A large prospective study with longer follow up would be necessary to better answer the question of how often atypical nevi evolve into melanoma and over what time period this occurs.
非典型痣的定义和处理仍是一个有争议的问题。一些人认为非典型痣是良性黑素细胞痣的常见变体，而另一些人则认为它们是介于良性黑素细胞痣和黑色素瘤之间的病变。因此，为防止部分切除的非典型痣演变成黑色素瘤，是否应以切缘阴性再次切除这一问题仍未得到解答。尽管研究表明大多数非典型痣永远不会发展成黑色素瘤，但当活检切缘阳性时，再次切除是普遍做法。我们认为在这种情况下再次切除没有必要。
我们的队列研究纳入了55例先前活检过的非典型痣，这些痣未进行再次切除，并进行了至少5年的随访，平均随访时间为6.12年。
实验组包括26例活检显示至少有一个切缘受累的非典型痣。对照组包括29例活检显示切缘阴性的非典型痣。在随访期间，实验组和对照组中均未观察到与既往非典型痣相关的黑色素瘤发生。
我们的研究结果支持对切除不完全的非典型痣进行观察，这是一种安全的替代再次切除的方法。需要进行一项随访时间更长的大型前瞻性研究，以更好地回答非典型痣演变成黑色素瘤的频率以及发生的时间段等问题。
