Wall Nerilee, De'Ambrosis Brian, Muir Jim
Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
South East Dermatology, Brisbane, Queensland, Australia.
Australas J Dermatol. 2017 Nov;58(4):304-307. doi: 10.1111/ajd.12720. Epub 2017 Nov 2.
BACKGROUND/OBJECTIVES: The management of dysplastic naevi based on histopathological grading is a contentious issue. Comprehensive management guidelines are lacking and the approach taken varies between clinicians. The authors sought to understand how Australian dermatologists approach the management of biopsy-proven dysplastic naevi, and the impact of grading of dysplasia upon this management.
In total, 547 Fellows of the Australasian College of Dermatologists were surveyed and 218 responses were collected (40% response rate).
Although all dermatologists surveyed would re-excise an incompletely removed severely dysplastic naevus, opinion was divided over whether to treat such a lesion as an in situ melanoma or a dysplastic naevus, with 55% of respondents using a 5-mm margin and the remainder opting for narrow margin re-excision. When the same lesion was reported to be clear of margins by 1 mm after biopsy and the clinical suspicion for melanoma was high, 44% would re-excise with a 5-mm margin.
The approach of Australian dermatologists to the management of dysplastic naevi varies between clinicians, reflecting the problems raised by the validity of histopathological grading.
背景/目的：基于组织病理学分级的发育异常痣的管理是一个有争议的问题。缺乏全面的管理指南，临床医生采取的方法也各不相同。作者试图了解澳大利亚皮肤科医生如何处理经活检证实的发育异常痣，以及发育异常分级对这种管理的影响。
总共对547名澳大利亚皮肤科医学院院士进行了调查，收集到218份回复（回复率为40%）。
尽管所有接受调查的皮肤科医生都会再次切除切除不完全的重度发育异常痣，但对于将此类病变视为原位黑色素瘤还是发育异常痣存在分歧，55%的受访者采用5毫米切缘，其余受访者选择窄切缘再次切除。当活检后报告同一病变切缘距肿瘤1毫米且临床高度怀疑为黑色素瘤时，44%的人会采用5毫米切缘再次切除。
澳大利亚皮肤科医生对发育异常痣的处理方法因临床医生而异，这反映了组织病理学分级有效性所引发的问题。
