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

• Type of Material: Article
• Authors: Caroline C. Kim, Harvard Medical School; Elizabeth G. Berry, Emory University; Michael A. Marchetti, Memorial Sloan Kettering Cancer Center; Susan M. Swetter, Stanford University; Geoffrey Lim, University of Pittsburgh; Douglas Grossman, University of Utah; Clara Curiel-Lewandrowski, University of Arizona; Emily Y. Chu, University of Pennsylvania; Michael E. Ming, University of Pennsylvania; Kathleen Zhu, University of Massachusetts; Meera Brahmbhatt, Emory University; Vijay Balakrishnan, Emory University; Michael Davis, Emory University; Zachary Wolner, Memorial Sloan Kettering Cancer Center; Nathaniel Fleming, Stanford University; Laura K. Ferris, University of Pittsburgh; John Nguyen, University of Utah; Oleksandr Trofymenko, University of Arizona; Yuan Liu, Emory University; Suephy Chen, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: American Medical Association (AMA)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 American Medical Association. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1001/jamadermatol.2018.3359
• Title of Journal or Parent Work: JAMA Dermatology
• ISSN: 2168-6068
• Volume: 154
• Issue: 12
• Start Page: 1401
• End Page: 1408
• Grant/Funding Information: Dr Marchetti’s work was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30CA008748.; Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource and the Summer Scholars Program of the Winship Cancer Institute of Emory University and National Institutes of Health/National Cancer Institute under award number P30CA138292.
• Keywords: MELANOCYTIC NEVI; Science & Technology; RECOGNITION; Dermatology; RECURRENCE; Life Sciences & Biomedicine; MANAGEMENT
• Research Categories: Health Sciences, Oncology

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.