ORIGINAL ARTICLES The utility of re-excising mildly and moderately dysplastic nevi: A retrospective analysis Lauren Strazzula, BA, a Priyanka Vedak, BA, a Mai P. Hoang, MD, b Arthur Sober, MD, a Hensin Tsao, MD, PhD, a and Daniela Kroshinsky, MD, MPH a Boston, Massachusetts See related letter on page 1257 Background: The management of dysplastic nevi (DN) is a highly debated and controversial topic within the dermatology community. Clinicians agree that margin-positive severely DN should be removed with a surgical margin, however, there is disagreement surrounding the appropriate management of margin-positive mildly and moderately DN. Objective: We sought to evaluate the utility of re-excising margin-positive mildly and moderately DN. Methods: A retrospective chart review was conducted on all adult patients given the diagnosis of a biopsy-proven DN from 2010 through 2011. The primary outcomes were defined as the presence of melanocytic residuum in re-excisional specimens and a clinically significant change in diagnosis. Results: A total of 1809 mildly and moderately DN were diagnosed from 2010 through 2011. In all, 765 (42.3%) of these lesions were found to have positive surgical margins during biopsy, and 495 (64.7) of the 765 lesions were subsequently re-excised. Melanocytic residuum was present in 18.2% of re-excisional specimens. Re-excision resulted in a clinically significant alteration of the diagnosis in only 1 case (0.2%). Limitations: Limitations include retrospective design and inability to assess for malignant transformation given limited follow-up. Conclusions: Re-excising mildly and moderately DN results in a low histopathological yield and rarely results in a clinically significant change in diagnosis. As such, clinical monitoring of margin-positive lesions may be warranted. ( J Am Acad Dermatol 2014;71:1071-6.) Key words: dermatopathology; dysplastic nevus; melanoma; nevus; pigmented lesions; surgical management. T he concept of the dysplastic nevus (DN) was first described in 1978 by both Clark et al 1 and Lynch et al 2 in 2 separate publications describing a phenotypic syndrome in melanoma- prone families. The term ‘‘dysplastic nevus’’ itself was introduced 2 years later 3 and these publications classified the DN as a premalignant lesion. 1-3 In recent years, this very notion has become controver- sial in the dermatology and dermatopathology communities, 4-6 and ambiguity continues to exist surrounding the possible progression of these lesions to melanoma. The concept that the DN may represent a premalignant lesion is further propagated by the fact that many pathologists grade the atypia found in DN from mildly to severely dysplastic based on histopathological criteria. As a result of the continued debate within the scientific community surrounding the biological behavior of DN, there are From the Departments of Dermatology a and Pathology, b Massachusetts General Hospital. Funding sources: None. Conflicts of interest: None declared. Accepted for publication August 17, 2014. Reprint requests: Daniela Kroshinsky, MD, MPH, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, #200, Boston, MA 02114. E-mail: dkroshinsky@mgh.harvard. edu. Published online September 25, 2014. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.08.025 1071