Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford University Medical Center, Palo Alto, California3Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
JAMA Dermatol. 2015 Feb;151(2):212-8. doi: 10.1001/jamadermatol.2014.2694.
The management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence.
To outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how positive margins arise, (2) whether incompletely excised DN evolve into melanoma, (3) current data on the outcomes of DN with positive histologic margins, (4) consensus recommendations, and (5) a proposal for future studies, including a large-scale study to help guide the management of DN with positive margins.
The literature, including recent studies examining management and outcomes of DN with positive margins between 2009 to 2014, was reviewed.
A consensus statement by the PLS of the MPWG following review of the literature, group discussions, and a structured Delphi method consensus.
This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.
临床上非典型痣/发育不良痣（CAN/DN）的处理存在争议，几乎没有数据可用于指导该过程。DN 组织学切缘阳性的处理建议是通过 Delphi 方法制定的，目的是在黑色素瘤预防工作组（MPWG）色素病变子委员会（PLS）成员审查当前证据后，就 DN 组织学切缘阳性的处理达成共识。
概述与 CAN/DN 处理相关的关键问题：（1）CAN 的活检以及阳性切缘的出现方式，（2）未完全切除的 DN 是否会进展为黑色素瘤，（3）DN 组织学切缘阳性的现有数据，（4）共识建议，（5）未来研究的建议，包括一项大型研究，以帮助指导 DN 组织学切缘阳性的处理。
对文献进行了回顾，包括最近研究检查了 2009 年至 2014 年间 DN 组织学切缘阳性的处理和结局。
MPWG PLS 成员在审查文献、小组讨论和结构化 Delphi 方法共识后，提出了一项共识声明。
本共识声明审查了 CAN/DN 处理的复杂性。对文献的回顾以及两轮结构化 Delphi 共识得出了以下建议：（1）轻度和中度 DN 且切缘清晰者无需再次切除，（2）轻度 DN 活检组织学切缘阳性但无临床残留色素沉着者可安全观察而非再次切除，（3）中度 DN 组织学切缘阳性且无临床可见残留色素沉着者观察可能是合理的选择；然而，在这种临床情况下，需要更多的数据来做出明确的推荐。
