Laser & Skin Surgery Center of New York, New York, New York.
JAMA Dermatol. 2013 Aug;149(8):928-34. doi: 10.1001/jamadermatol.2013.4440.
To evaluate the effect of surgical excision, performed after biopsy diagnosis of dysplastic nevus, on final diagnosis, melanoma prevention, and melanoma detection.
DESIGN, SETTING, AND PARTICIPANTS: Outcome study using retrospective review conducted in an academic dermatopathology practice (Boston Medical Center Skin Pathology Laboratory) that receives specimens from community and academic practices across the United States. Consecutive patient pathology samples of dysplastic nevi and cutaneous melanomas evaluated between September 1, 1999 and March 1, 2011, and identified using systematized nomenclature of medicine codes were included.
In dysplastic nevi cases, the rate of clinically significant change in diagnosis and the rate of melanoma detection as a result of excision. In melanoma cases, the rate and characteristics of association with dysplastic nevus.
Of dysplastic nevi, 196 of 580 (34%) showed a positive biopsy margin, increasing with grade of atypia (P < .001); 127 of 196 with positive biopsy margin received excision (65%), performed more often as grade of atypia increased (P < .001). Two excisions (2 of 127, 1.6%) resulted in a clinically significant change in diagnosis, from biopsy-diagnosed moderately-to-severely dysplastic nevi before excision to melanoma in situ after excision. In melanomas (n = 216), in situ and superficial spreading subtypes were more often associated with dysplastic nevi (20% and 18%, respectively) (P = .002), most often of moderate-to-severe or severe grade.
Excision of biopsy-diagnosed mildly or moderately dysplastic nevi is unlikely to result in a clinically significant change in diagnosis, and risk of transformation to melanoma appears very low. Moderately-to-severely and severely dysplastic nevi are more often associated with melanoma, and excision may be beneficial for melanoma detection or prevention.
评估在活检诊断为发育不良痣后进行手术切除对最终诊断、预防黑色素瘤和检测黑色素瘤的效果。
设计、设置和参与者：使用回顾性研究，在一家学术皮肤科病理学实践机构（波士顿医疗中心皮肤病理学实验室）进行，该机构接收来自美国各地社区和学术实践的标本。纳入了 1999 年 9 月 1 日至 2011 年 3 月 1 日期间评估的连续患者病理样本，这些样本为发育不良痣和皮肤黑色素瘤，并使用医学系统命名法代码进行了识别。
在发育不良痣病例中，诊断上的临床显著变化率和由于切除而检测到黑色素瘤的比率。在黑色素瘤病例中，与发育不良痣相关的关联率和特征。
在 580 例发育不良痣中，196 例（34%）活检边缘呈阳性，随着异型程度的增加而增加（P < .001）；196 例活检边缘阳性中有 127 例（65%）接受了切除（P < .001），随着异型程度的增加，切除的频率也增加。两次切除（2 例中有 2 例，1.6%）导致诊断上的临床显著变化，从切除前活检诊断为中度至重度发育不良痣转变为切除后原位黑色素瘤。在黑色素瘤（n = 216）中，原位和浅表扩散型更常与发育不良痣相关（分别为 20%和 18%）（P = .002），最常见的异型程度为中度至重度或重度。
切除活检诊断为轻度或中度发育不良痣不太可能导致诊断上的临床显著变化，而且转化为黑色素瘤的风险似乎非常低。中重度和重度发育不良痣更常与黑色素瘤相关，切除可能有助于检测或预防黑色素瘤。
