A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi

Vitaly Terushkin, Elise Ng, Jennifer A. Stein, Susan Katz, David E. Cohen, Shane Meehan, David Polsky

Research output: Contribution to journalArticle

Abstract

Background Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen. Objective To evaluate the clinical and histopathologic outcomes of in toto biopsy of DN using a predetermined margin of normal skin. Methods We conducted a prospective study of a saucerization method using a defined 2-mm margin in patients undergoing biopsy of a pigmented skin lesion. Results We performed 151 biopsies in 138 patients. Overall, 137 of 151 lesions subjected to biopsy (90.7%) were melanocytic: 86 DN (57.0%), 40 nevi without atypia (26.5%), and 11 melanomas (7.3%). Of 78 DN, 68 (87.2%) were removed with clear histopathologic margins (8 DN were excluded because of inadequate processing). There was no clinical evidence of recurrence at any of the biopsy sites that were simply observed (i.e., not re-excised) over a median of 16.9 months. Limitations There were few biopsies performed on the face. Conclusions The complete histopathologic removal of nearly 9 of 10 DN using a peripheral margin of 2 mm of normal skin and a depth at the dermis and subcutaneous fat junction has the potential to decrease second procedures at DN biopsy sites, thereby decreasing patient morbidity and saving health care dollars.

Original languageEnglish (US)
Pages (from-to)1096-1099
Number of pages4
JournalJournal of the American Academy of Dermatology
Volume77
Issue number6
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Dysplastic Nevus Syndrome
Prospective Studies
Biopsy
Skin
Nevus
Subcutaneous Fat
Dermis
Melanoma
Morbidity
Delivery of Health Care
Recurrence

Keywords

  • atopic nevi
  • biopsy
  • dysplastic nevi
  • margin
  • melanoma
  • prospective
  • removal
  • saucerization

ASJC Scopus subject areas

  • Dermatology

Cite this

A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi. / Terushkin, Vitaly; Ng, Elise; Stein, Jennifer A.; Katz, Susan; Cohen, David E.; Meehan, Shane; Polsky, David.

In: Journal of the American Academy of Dermatology, Vol. 77, No. 6, 01.12.2017, p. 1096-1099.

Research output: Contribution to journalArticle

Terushkin, Vitaly ; Ng, Elise ; Stein, Jennifer A. ; Katz, Susan ; Cohen, David E. ; Meehan, Shane ; Polsky, David. / A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi. In: Journal of the American Academy of Dermatology. 2017 ; Vol. 77, No. 6. pp. 1096-1099.
@article{61db20c895d5466797679a60c677c1fa,
title = "A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi",
abstract = "Background Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen. Objective To evaluate the clinical and histopathologic outcomes of in toto biopsy of DN using a predetermined margin of normal skin. Methods We conducted a prospective study of a saucerization method using a defined 2-mm margin in patients undergoing biopsy of a pigmented skin lesion. Results We performed 151 biopsies in 138 patients. Overall, 137 of 151 lesions subjected to biopsy (90.7{\%}) were melanocytic: 86 DN (57.0{\%}), 40 nevi without atypia (26.5{\%}), and 11 melanomas (7.3{\%}). Of 78 DN, 68 (87.2{\%}) were removed with clear histopathologic margins (8 DN were excluded because of inadequate processing). There was no clinical evidence of recurrence at any of the biopsy sites that were simply observed (i.e., not re-excised) over a median of 16.9 months. Limitations There were few biopsies performed on the face. Conclusions The complete histopathologic removal of nearly 9 of 10 DN using a peripheral margin of 2 mm of normal skin and a depth at the dermis and subcutaneous fat junction has the potential to decrease second procedures at DN biopsy sites, thereby decreasing patient morbidity and saving health care dollars.",
keywords = "atopic nevi, biopsy, dysplastic nevi, margin, melanoma, prospective, removal, saucerization",
author = "Vitaly Terushkin and Elise Ng and Stein, {Jennifer A.} and Susan Katz and Cohen, {David E.} and Shane Meehan and David Polsky",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.jaad.2017.07.016",
language = "English (US)",
volume = "77",
pages = "1096--1099",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - A prospective study evaluating the utility of a 2-mm biopsy margin for complete removal of histologically atypical (dysplastic) nevi

AU - Terushkin, Vitaly

AU - Ng, Elise

AU - Stein, Jennifer A.

AU - Katz, Susan

AU - Cohen, David E.

AU - Meehan, Shane

AU - Polsky, David

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen. Objective To evaluate the clinical and histopathologic outcomes of in toto biopsy of DN using a predetermined margin of normal skin. Methods We conducted a prospective study of a saucerization method using a defined 2-mm margin in patients undergoing biopsy of a pigmented skin lesion. Results We performed 151 biopsies in 138 patients. Overall, 137 of 151 lesions subjected to biopsy (90.7%) were melanocytic: 86 DN (57.0%), 40 nevi without atypia (26.5%), and 11 melanomas (7.3%). Of 78 DN, 68 (87.2%) were removed with clear histopathologic margins (8 DN were excluded because of inadequate processing). There was no clinical evidence of recurrence at any of the biopsy sites that were simply observed (i.e., not re-excised) over a median of 16.9 months. Limitations There were few biopsies performed on the face. Conclusions The complete histopathologic removal of nearly 9 of 10 DN using a peripheral margin of 2 mm of normal skin and a depth at the dermis and subcutaneous fat junction has the potential to decrease second procedures at DN biopsy sites, thereby decreasing patient morbidity and saving health care dollars.

AB - Background Complete removal of individual dysplastic nevi (DN) is often accomplished by a second surgical procedure after the initial biopsy. The choice to perform the second procedure is strongly influenced by histopathologic margin status of the initial biopsy specimen. Objective To evaluate the clinical and histopathologic outcomes of in toto biopsy of DN using a predetermined margin of normal skin. Methods We conducted a prospective study of a saucerization method using a defined 2-mm margin in patients undergoing biopsy of a pigmented skin lesion. Results We performed 151 biopsies in 138 patients. Overall, 137 of 151 lesions subjected to biopsy (90.7%) were melanocytic: 86 DN (57.0%), 40 nevi without atypia (26.5%), and 11 melanomas (7.3%). Of 78 DN, 68 (87.2%) were removed with clear histopathologic margins (8 DN were excluded because of inadequate processing). There was no clinical evidence of recurrence at any of the biopsy sites that were simply observed (i.e., not re-excised) over a median of 16.9 months. Limitations There were few biopsies performed on the face. Conclusions The complete histopathologic removal of nearly 9 of 10 DN using a peripheral margin of 2 mm of normal skin and a depth at the dermis and subcutaneous fat junction has the potential to decrease second procedures at DN biopsy sites, thereby decreasing patient morbidity and saving health care dollars.

KW - atopic nevi

KW - biopsy

KW - dysplastic nevi

KW - margin

KW - melanoma

KW - prospective

KW - removal

KW - saucerization

UR - http://www.scopus.com/inward/record.url?scp=85030235371&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030235371&partnerID=8YFLogxK

U2 - 10.1016/j.jaad.2017.07.016

DO - 10.1016/j.jaad.2017.07.016

M3 - Article

C2 - 28982585

AN - SCOPUS:85030235371

VL - 77

SP - 1096

EP - 1099

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

SN - 0190-9622

IS - 6

ER -