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Margin comments on histopathologically dysplastic nevi resulted in lower re-excision rates

Patients with histopathologically dysplastic nevi whose reports included standardized margin comments had significantly lower re-excision rates than those without margin comments, according to retrospective study results.

Researchers reviewed dermatopathology reports to compare re-excision rates of histopathologically dysplastic nevi (HDN) with standardized margin comments (MCs) from May 2011 through June 2012 and HDN without standardized MCs from January 2007 to December 2010. Surveys were distributed to clinicians to gauge perceptions on the impact MCs had on the management of HDN.

Three hundred two of 584 HDN (55.6% women) had MCs. A significantly higher rate of patients without MCs had re-excision recommended or performed (51.8%) compared with patients with MC (39.4%; P=.003 regardless of margin status). While the difference was observed in mildly or moderately dysplastic HDN, it was not seen in patients with severe dysplasia.

Seventy-two percent of clinicians (n=40) completed surveys, with 16 respondents reporting they would be “more likely to biopsy pigmented lesions with a clinical margin of normal-appearing skin than they were before MCs were routinely included in dermatopathology reports.”

“Our results clearly demonstrated that the rates of recommendation for re-excision were significantly higher in the nonmargin comment group as compared with the margin comment group,” the researchers concluded. “Management of melanocytic nevi is a common problem that carries high health care cost and use. Because the dermatopathology report is integral to clinical decisions, efforts to understand how diagnostic terminology and specific comments on histopathologic findings influence clinical management deserve further attention.”

Disclosure: The researchers report no relevant financial disclosures.