Dysplastic nevi with severe atypia: Long-term outcomes in patients with and without re-excision

Background: Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited. Objective: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. Methods: A retrospective single institutional study was conducted with 451 adult patients (mean age 41.3 years) with SDN biopsied between November 1994 and November 2004, with clinical follow-up of at least 5 years. Results: In 451 patients with SDN, re- excision was performed on 36.6%. Two melanomas were diagnosed in the re- excision specimens. Subsequent metastatic melanoma developed in 7 patients, all of whom had a history of melanoma. Margin comments influenced decision to re-excise. Limitations: This was a retrospective study at a single institution. Conclusion: Re-excision of all SDN may not be necessary.