Baeza-Hernández G, Rubio-Aguilera R F, Martínez-Morán C, Álvarez-Garrido H, Garrido-Ríos A A, Borbujo J
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
Actas Dermosifiliogr. 2023 Nov-Dec;114(10):T850-T857. doi: 10.1016/j.ad.2023.09.016. Epub 2023 Sep 19.
There are no clinical guidelines on the management of dysplastic nevus (DN). The aims of this study were to determine the percentage of dermatologists in the center-Spain section of the Spanish Academy of Dermatology and Venereology (AEDV) who would manage a histologically confirmed DN with a watch-and-wait approach or with wider surgical margins and to investigate whether their attitudes would vary depending on whether or not the patient had a personal and/or family history of melanoma.
We collected data from an anonymous survey sent to 738 dermatologists between June 15 and July 31, 2022. The independent variables were degree of dysplasia (low vs. high), margin status (positive vs. negative), and a personal or family history of melanoma (yes vs. no in both cases). The dependent variables were attitude towards management (watch-and-wait vs. re-excision with a surgical margin of 1 to 4mm or re-excision with a surgical margin of 5 to 10mm).
We obtained 86 responses to the questionnaire. When pathology indicated a low-grade DN, 60.5% of dermatologists stated they would obtain a surgical margin of 1 to 4mm if the first margins were positive, and 97.7% would watch and wait if the report described negative margins. For high-grade DNs, 1.2% of dermatologists would watch and wait to manage DN with positive margins; 68.8% would use this approach for negative margins. A family or personal history of melanoma had no influence on most of the dermatologists' attitudes.
Management strategies for DN among dermatologists from the center-Spain section of the AEDV varied, particularly when faced with low-grade DN with positive margins and high-grade DN with negative margins. A family or personal history of melanoma did not influence clinical attitudes in most cases.
目前尚无关于发育异常痣(DN)管理的临床指南。本研究的目的是确定西班牙皮肤病与性病学会(AEDV)西班牙中部地区皮肤科医生中,会采用观察等待方法或更宽手术切缘来处理经组织学确诊的DN的比例,并调查他们的态度是否会因患者有无个人和/或家族黑色素瘤病史而有所不同。
我们收集了2022年6月15日至7月31日期间发送给738名皮肤科医生的匿名调查问卷数据。自变量为发育异常程度(低级别与高级别)、切缘状态(阳性与阴性)以及个人或家族黑色素瘤病史(两者均为是与否)。因变量为对管理的态度(观察等待与手术切缘为1至4毫米的再次切除或手术切缘为5至10毫米的再次切除)。
我们收到了86份问卷回复。当病理显示为低级别DN时,如果初次切缘为阳性,60.5%的皮肤科医生表示他们会进行手术切缘为1至4毫米的再次切除;如果报告描述切缘为阴性,97.7%的医生会选择观察等待。对于高级别DN,1.2%的皮肤科医生会对切缘阳性的DN选择观察等待;68.8%的医生会对切缘阴性的DN采用这种方法。黑色素瘤的家族或个人病史对大多数皮肤科医生的态度没有影响。
AEDV西班牙中部地区皮肤科医生对DN的管理策略各不相同,尤其是在面对切缘阳性的低级别DN和切缘阴性的高级别DN时。在大多数情况下,黑色素瘤的家族或个人病史并未影响临床态度。