Observation of Moderately Dysplastic Nevi With Positive Margins

The management of dysplastic nevi is a quotidian part of the clinical practice of dermatology, yet even directors of pigmented lesion clinics in the United States demonstrate significant practice variation with observation or therapeutic excision of dysplastic nevi. This scenario is particularly true for biopsies of dysplastic nevi that have histologically positive margins. A 2015 consensus statement summarizing this practice gap included a call for further study of this common clinical question. There are several important challenges in establishing evidence-based guidelines for the management of dysplastic nevi, and thus establishing practice consensus for the management of dysplastic nevi, including the lack of definitive evidence that dysplastic nevi are precursor lesions to melanoma, interobserver histopathologic variation in gradation of dysplasia, longitudinal risk of monitoring for clinical recurrence, and variation in diagnostic biopsy procedures (ie, risk of incisional or partial biopsies).