Surgical re-excision vs. observation for histologically dysplastic naevi: a systematic review of associated clinical outcomes

K. T. Vuong, J. Walker, H. B. Powell, N. E. Thomas, D. E. Jonas, A. S. Adamson

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background: The management of histologically dysplastic naevi (HDN) with re-excision vs. observation remains controversial because of lack of evidence about associated melanoma outcomes. Objectives: To assess published data on the development of biopsy-site primary cutaneous melanoma among biopsy-proven HDN managed with either re-excision or observation. Methods: A systematic review of all published data: a total of 5293 records were screened, 18 articles were assessed in full text and 12 studies met inclusion criteria. No controlled trials were identified. Results: Most studies (11 of 12, 92%) were retrospective chart reviews, and one was both a cross-sectional and cohort study. Many studies (nine of 12, 75%) had no head-to-head comparison groups and either only reported HDN that were re-excised or observed. A total of 2673 (1535 observed vs. 1138 re-excised) HDN of various grades were included. Follow-up varied between 2 weeks and 30 years. Nine studies reported that no melanomas developed. Eleven biopsy-site melanomas developed across three of the studies, six among observed lesions (0·39%) and five among re-excised lesions (0·44%). Conclusions: Based upon the available evidence the rates of biopsy-site primary melanoma were similarly low among observed lesions and re-excised lesions. This suggests that HDNs can be observed with minimal adverse melanoma-associated outcomes. However, all included articles were of low quality and further prospective trials could better guide clinical decision making.

Original languageEnglish (US)
Pages (from-to)590-598
Number of pages9
JournalBritish Journal of Dermatology
Volume179
Issue number3
DOIs
StatePublished - Sep 2018

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Dysplastic Nevus Syndrome
Melanoma
Observation
Biopsy
Cohort Studies
Cross-Sectional Studies
Skin

ASJC Scopus subject areas

  • Dermatology

Cite this

Surgical re-excision vs. observation for histologically dysplastic naevi : a systematic review of associated clinical outcomes. / Vuong, K. T.; Walker, J.; Powell, H. B.; Thomas, N. E.; Jonas, D. E.; Adamson, A. S.

In: British Journal of Dermatology, Vol. 179, No. 3, 09.2018, p. 590-598.

Research output: Contribution to journalReview article

Vuong, K. T. ; Walker, J. ; Powell, H. B. ; Thomas, N. E. ; Jonas, D. E. ; Adamson, A. S. / Surgical re-excision vs. observation for histologically dysplastic naevi : a systematic review of associated clinical outcomes. In: British Journal of Dermatology. 2018 ; Vol. 179, No. 3. pp. 590-598.
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abstract = "Background: The management of histologically dysplastic naevi (HDN) with re-excision vs. observation remains controversial because of lack of evidence about associated melanoma outcomes. Objectives: To assess published data on the development of biopsy-site primary cutaneous melanoma among biopsy-proven HDN managed with either re-excision or observation. Methods: A systematic review of all published data: a total of 5293 records were screened, 18 articles were assessed in full text and 12 studies met inclusion criteria. No controlled trials were identified. Results: Most studies (11 of 12, 92{\%}) were retrospective chart reviews, and one was both a cross-sectional and cohort study. Many studies (nine of 12, 75{\%}) had no head-to-head comparison groups and either only reported HDN that were re-excised or observed. A total of 2673 (1535 observed vs. 1138 re-excised) HDN of various grades were included. Follow-up varied between 2 weeks and 30 years. Nine studies reported that no melanomas developed. Eleven biopsy-site melanomas developed across three of the studies, six among observed lesions (0·39{\%}) and five among re-excised lesions (0·44{\%}). Conclusions: Based upon the available evidence the rates of biopsy-site primary melanoma were similarly low among observed lesions and re-excised lesions. This suggests that HDNs can be observed with minimal adverse melanoma-associated outcomes. However, all included articles were of low quality and further prospective trials could better guide clinical decision making.",
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N2 - Background: The management of histologically dysplastic naevi (HDN) with re-excision vs. observation remains controversial because of lack of evidence about associated melanoma outcomes. Objectives: To assess published data on the development of biopsy-site primary cutaneous melanoma among biopsy-proven HDN managed with either re-excision or observation. Methods: A systematic review of all published data: a total of 5293 records were screened, 18 articles were assessed in full text and 12 studies met inclusion criteria. No controlled trials were identified. Results: Most studies (11 of 12, 92%) were retrospective chart reviews, and one was both a cross-sectional and cohort study. Many studies (nine of 12, 75%) had no head-to-head comparison groups and either only reported HDN that were re-excised or observed. A total of 2673 (1535 observed vs. 1138 re-excised) HDN of various grades were included. Follow-up varied between 2 weeks and 30 years. Nine studies reported that no melanomas developed. Eleven biopsy-site melanomas developed across three of the studies, six among observed lesions (0·39%) and five among re-excised lesions (0·44%). Conclusions: Based upon the available evidence the rates of biopsy-site primary melanoma were similarly low among observed lesions and re-excised lesions. This suggests that HDNs can be observed with minimal adverse melanoma-associated outcomes. However, all included articles were of low quality and further prospective trials could better guide clinical decision making.

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