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Journal of the American Academy of Dermatology

Margin comments in dermatopathology reports on dysplastic nevi influence re-excision rates.


PMID 23932648

Abstract

Dermatopathology reports influence clinical management, but it is not clear to what extent comments on margin involvement of histopathologically dysplastic nevi (HDN) influence decisions about re-excision or complete excision. We sought to determine if standardized margin comments (MCs) on HDN influence re-excision rates. By reviewing medical records, we compared re-excision rates of HDN reported with (May 2011 to December 2012) and without (January 2007 to December 2010) standardized MCs, and surveyed clinicians to assess perceptions of the impact of MCs on their management of HDN. Of 584 HDN, 302 had MCs and 282 did not. Re-excision was recommended or performed at a significantly higher rate for patients in the group without MCs (51.8%, 146 of 282) than in the MC group (39.4%, 119 of 302); P = .003 regardless of margin status. This difference was observed among HDN diagnosed as mildly and moderately dysplastic but not for severely dysplastic nevi. In all, 40% (16 of 40) of clinicians responded that they are 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. This was a retrospective study. Re-excision rates were significantly lower in patients who had HDN reported with standardized MCs. MCs may help reduce re-excision rates, with associated reduction in health care use, cost, and morbidity.

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