Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins

Caroline C. Kim, Elizabeth Berry, Michael A. Marchetti, Susan M. Swetter, Geoffrey Lim, Douglas Grossman, Clara Curiel-Lewandrowski, Emily Y. Chu, Michael E. Ming, Kathleen Zhu, Meera Brahmbhatt, Vijay Balakrishnan, Michael J. Davis, Zachary Wolner, Nathaniel Fleming, Laura K. Ferris, John Nguyen, Oleksandr Trofymenko, Yuan Liu, Suephy C. Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P <.001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P =.01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

Original languageEnglish (US)
Pages (from-to)1401-1408
Number of pages8
JournalJAMA Dermatology
Volume154
Issue number12
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Dysplastic Nevus Syndrome
Melanoma
Skin
Biopsy
Logistic Models
Odds Ratio
Pigmentation
Dermatology
Analysis of Variance
Cohort Studies
Multivariate Analysis
Retrospective Studies
Observation
Demography
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Dermatology

Cite this

Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins. / Kim, Caroline C.; Berry, Elizabeth; Marchetti, Michael A.; Swetter, Susan M.; Lim, Geoffrey; Grossman, Douglas; Curiel-Lewandrowski, Clara; Chu, Emily Y.; Ming, Michael E.; Zhu, Kathleen; Brahmbhatt, Meera; Balakrishnan, Vijay; Davis, Michael J.; Wolner, Zachary; Fleming, Nathaniel; Ferris, Laura K.; Nguyen, John; Trofymenko, Oleksandr; Liu, Yuan; Chen, Suephy C.

In: JAMA Dermatology, Vol. 154, No. 12, 01.12.2018, p. 1401-1408.

Research output: Contribution to journalArticle

Kim, CC, Berry, E, Marchetti, MA, Swetter, SM, Lim, G, Grossman, D, Curiel-Lewandrowski, C, Chu, EY, Ming, ME, Zhu, K, Brahmbhatt, M, Balakrishnan, V, Davis, MJ, Wolner, Z, Fleming, N, Ferris, LK, Nguyen, J, Trofymenko, O, Liu, Y & Chen, SC 2018, 'Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins', JAMA Dermatology, vol. 154, no. 12, pp. 1401-1408. https://doi.org/10.1001/jamadermatol.2018.3359
Kim, Caroline C. ; Berry, Elizabeth ; Marchetti, Michael A. ; Swetter, Susan M. ; Lim, Geoffrey ; Grossman, Douglas ; Curiel-Lewandrowski, Clara ; Chu, Emily Y. ; Ming, Michael E. ; Zhu, Kathleen ; Brahmbhatt, Meera ; Balakrishnan, Vijay ; Davis, Michael J. ; Wolner, Zachary ; Fleming, Nathaniel ; Ferris, Laura K. ; Nguyen, John ; Trofymenko, Oleksandr ; Liu, Yuan ; Chen, Suephy C. / Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins. In: JAMA Dermatology. 2018 ; Vol. 154, No. 12. pp. 1401-1408.
@article{6dba999d26654af5bbf522ecccd1e6a9,
title = "Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins",
abstract = "Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8{\%}) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95{\%} CI, 5.71-24.15; P <.001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95{\%} CI, 1.23-5.28; P =.01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5{\%}). Three of 40 cases (7.5{\%}) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.",
author = "Kim, {Caroline C.} and Elizabeth Berry and Marchetti, {Michael A.} and Swetter, {Susan M.} and Geoffrey Lim and Douglas Grossman and Clara Curiel-Lewandrowski and Chu, {Emily Y.} and Ming, {Michael E.} and Kathleen Zhu and Meera Brahmbhatt and Vijay Balakrishnan and Davis, {Michael J.} and Zachary Wolner and Nathaniel Fleming and Ferris, {Laura K.} and John Nguyen and Oleksandr Trofymenko and Yuan Liu and Chen, {Suephy C.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1001/jamadermatol.2018.3359",
language = "English (US)",
volume = "154",
pages = "1401--1408",
journal = "JAMA Dermatology",
issn = "2168-6068",
publisher = "American Medical Association",
number = "12",

}

TY - JOUR

T1 - Risk of Subsequent Cutaneous Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but with Positive Histologic Margins

AU - Kim, Caroline C.

AU - Berry, Elizabeth

AU - Marchetti, Michael A.

AU - Swetter, Susan M.

AU - Lim, Geoffrey

AU - Grossman, Douglas

AU - Curiel-Lewandrowski, Clara

AU - Chu, Emily Y.

AU - Ming, Michael E.

AU - Zhu, Kathleen

AU - Brahmbhatt, Meera

AU - Balakrishnan, Vijay

AU - Davis, Michael J.

AU - Wolner, Zachary

AU - Fleming, Nathaniel

AU - Ferris, Laura K.

AU - Nguyen, John

AU - Trofymenko, Oleksandr

AU - Liu, Yuan

AU - Chen, Suephy C.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P <.001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P =.01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

AB - Importance: Little evidence exists to guide the management of moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins (hereafter referred to as moderately dysplastic nevi with positive histologic margins). Objective: To determine outcomes and risk for the development of subsequent cutaneous melanoma (CM) from moderately dysplastic nevi with positive histologic margins observed for 3 years or more. Design, Setting, and Participants: A multicenter (9 US academic dermatology sites) retrospective cohort study was conducted of patients 18 years or older with moderately dysplastic nevi with positive histologic margins and 3 years or more of follow-up data collected consecutively from January 1, 1990, to August 31, 2014. Records were reviewed for patient demographics, biopsy type, pathologic findings, and development of subsequent CM at the biopsy site or elsewhere on the body. The χ2 test, the Fisher exact test, and analysis of variance were used to assess univariate association for risk of subsequent CMs, in addition to multivariable logistic regression models. To confirm histologic grading, each site submitted 5 random representative slide cases for central dermatopathologic review. Statistical analysis was performed from October 1, 2017, to June 22, 2018. Main Outcomes and Measures: Development of CM at a biopsy site or elsewhere on the body where there were moderately dysplastic nevi with positive histologic margins. Results: A total of 467 moderately dysplastic nevi with positive histologic margins from 438 patients (193 women and 245 men; mean [SD] age, 46.7 [16.1] years) were evaluated. No cases developed into CM at biopsy sites, with a mean (SD) follow-up time of 6.9 (3.4) years. However, 100 patients (22.8%) developed a CM at a separate site. Results of multivariate analyses revealed that history of CM was significantly associated with the risk of development of subsequent CM at a separate site (odds ratio, 11.74; 95% CI, 5.71-24.15; P <.001), as were prior biopsied dysplastic nevi (odds ratio, 2.55; 95% CI, 1.23-5.28; P =.01). The results of a central dermatopathologic review revealed agreement in 35 of 40 cases (87.5%). Three of 40 cases (7.5%) were upgraded in degree of atypia; of these, 1 was interpreted as melanoma in situ. That patient remains without recurrence or evidence of CM after 5 years of follow-up. Conclusions and Relevance: This study suggests that close observation with routine skin surveillance is a reasonable management approach for moderately dysplastic nevi with positive histologic margins. However, having 2 or more biopsied dysplastic nevi (with 1 that is a moderately dysplastic nevus) appears to be associated with increased risk for subsequent CM at a separate site.

UR - http://www.scopus.com/inward/record.url?scp=85054793102&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054793102&partnerID=8YFLogxK

U2 - 10.1001/jamadermatol.2018.3359

DO - 10.1001/jamadermatol.2018.3359

M3 - Article

VL - 154

SP - 1401

EP - 1408

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 12

ER -