PMID- 25409291
OWN - NLM
STAT- MEDLINE
DCOM- 20150421
LR  - 20160524
IS  - 2168-6084 (Electronic)
IS  - 2168-6068 (Linking)
VI  - 151
IP  - 2
DP  - 2015 Feb
TI  - Addressing the knowledge gap in clinical recommendations for management and 
      complete excision of clinically atypical nevi/dysplastic nevi: Pigmented Lesion 
      Subcommittee consensus statement.
PG  - 212-8
LID - 10.1001/jamadermatol.2014.2694 [doi]
AB  - IMPORTANCE: The management of clinically atypical nevi/dysplastic nevi (CAN/DN) 
      is controversial, with few data to guide the process. Management recommendations 
      for DN with positive histologic margins were developed by the Delphi method to 
      achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the 
      Melanoma Prevention Working Group (MPWG) after reviewing the current evidence. 
      OBJECTIVES: To outline key issues related to the management of CAN/DN: (1) 
      biopsies of CAN and how positive margins arise, (2) whether incompletely excised 
      DN evolve into melanoma, (3) current data on the outcomes of DN with positive 
      histologic margins, (4) consensus recommendations, and (5) a proposal for future 
      studies, including a large-scale study to help guide the management of DN with 
      positive margins. EVIDENCE REVIEW: The literature, including recent studies 
      examining management and outcomes of DN with positive margins between 2009 to 
      2014, was reviewed. FINDINGS: A consensus statement by the PLS of the MPWG 
      following review of the literature, group discussions, and a structured Delphi 
      method consensus. CONCLUSIONS AND RELEVANCE: This consensus statement reviews the 
      complexities of management of CAN/DN. A review of the literature and 2 rounds of 
      a structured Delphi consensus resulted in the following recommendations: (1) 
      mildly and moderately DN with clear margins do not need to be reexcised, (2) 
      mildly DN biopsied with positive histologic margins without clinical residual 
      pigmentation may be safely observed rather than reexcised, and (3) observation 
      may be a reasonable option for management of moderately DN with positive 
      histologic margins without clinically apparent residual pigmentation; however, 
      more data are needed to make definitive recommendations in this clinical 
      scenario.
FAU - Kim, Caroline C
AU  - Kim CC
AD  - Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of 
      Dermatology, Harvard Medical School, Beth Israel Deaconess Medical Center, 
      Boston, Massachusetts.
FAU - Swetter, Susan M
AU  - Swetter SM
AD  - Pigmented Lesion and Melanoma Program, Department of Dermatology, Stanford 
      University Medical Center, Palo Alto, California3Dermatology Service, Veterans 
      Affairs Palo Alto Health Care System, Palo Alto, California.
FAU - Curiel-Lewandrowski, Clara
AU  - Curiel-Lewandrowski C
AD  - Pigmented Lesion Clinic and Multidisciplinary Cutaneous Oncology Program, 
      Division of Dermatology, Department of Medicine, University of Arizona, Tucson.
FAU - Grichnik, James M
AU  - Grichnik JM
AD  - Melanoma Program, Department of Dermatology, Miller School of Medicine, 
      University of Miami, Miami, Florida.
FAU - Grossman, Douglas
AU  - Grossman D
AD  - Pigmented Lesion Clinic, Departments of Dermatology and Oncological Sciences, 
      Huntsman Cancer Institute, University of Utah, Salt Lake City.
FAU - Halpern, Allan C
AU  - Halpern AC
AD  - Pigmented Lesion Clinic, Dermatology Service, Department of Medicine, Memorial 
      Sloan Kettering Cancer Center, New York, New York.
FAU - Kirkwood, John M
AU  - Kirkwood JM
AD  - Melanoma Program, University of Pittsburgh Cancer Institute, Department of 
      Medicine, Dermatology and Translational Science, University of Pittsburgh, 
      Pittsburgh, Pennsylvania.
FAU - Leachman, Sancy A
AU  - Leachman SA
AD  - Melanoma and Cutaneous Oncology Program, Department of Dermatology, Oregon Health 
      and Science University, Portland.
FAU - Marghoob, Ashfaq A
AU  - Marghoob AA
AD  - Pigmented Lesion Clinic, Dermatology Service, Department of Medicine, Memorial 
      Sloan Kettering Cancer Center, New York, New York.
FAU - Ming, Michael E
AU  - Ming ME
AD  - Pigmented Lesion Clinic, Department of Dermatology, University of Pennsylvania, 
      Philadelphia.
FAU - Nelson, Kelly C
AU  - Nelson KC
AD  - Pigmented Lesion Clinic, Department of Dermatology, Duke University Medical 
      Center, Durham, North Carolina.
FAU - Veledar, Emir
AU  - Veledar E
AD  - Center for Research and Grants, Baptist Health South Florida, Miami.
FAU - Venna, Suraj S
AU  - Venna SS
AD  - Skin Oncology and Melanoma Center, Department of Medicine, MedStar Washington 
      Cancer Institute and Georgetown University Medical Center, Washington, DC.
FAU - Chen, Suephy C
AU  - Chen SC
AD  - Melanoma and Pigmented Lesion Clinic, Department of Dermatology, Emory University 
      School of Medicine, Atlanta, Georgia15Division of Dermatology, Atlanta Veterans 
      Administration Medical Center, Decatur, Georgia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - JAMA Dermatol
JT  - JAMA dermatology
JID - 101589530
SB  - IM
MH  - *Consensus
MH  - Dermatologic Surgical Procedures/*standards
MH  - *Disease Management
MH  - Dysplastic Nevus Syndrome/*surgery
MH  - Humans
MH  - Melanoma/*surgery
MH  - *Practice Guidelines as Topic
MH  - Skin Neoplasms/*surgery
EDAT- 2014/11/20 06:00
MHDA- 2015/04/22 06:00
CRDT- 2014/11/20 06:00
PHST- 2014/11/20 06:00 [entrez]
PHST- 2014/11/20 06:00 [pubmed]
PHST- 2015/04/22 06:00 [medline]
AID - 1936086 [pii]
AID - 10.1001/jamadermatol.2014.2694 [doi]
PST - ppublish
SO  - JAMA Dermatol. 2015 Feb;151(2):212-8. doi: 10.1001/jamadermatol.2014.2694.