Outcomes of biopsies and excisions of dysplastic acral nevi: a study of 187 lesions.

BACKGROUND: Despite their frequency in clinical practice, controversy exists regarding the significance and management of dysplastic nevi (DN). Although the perception of DN as precursors to melanoma is questionable, excisions of biopsy-proven DN are commonplace in clinical practice. The management of dysplastic acral nevi is of interest given the challenge of surgery at acral sites.

OBJECTIVE: To determine the outcomes of biopsies of clinically atypical acral nevi and excisions of histologically dysplastic acral nevi (HDN).

MATERIALS AND METHODS: Retrospective review of consecutive patients at a private dermatology practice who had a biopsy of an atypical acral nevus from December 2004 to July 2012.

RESULTS: One hundred eighty-seven atypical acral nevi were biopsied from 168 patients (77 (41%) HDN, 108 (58%) common nevi). Based on initial histology, 30 (39%) HDN were recommended for excision and eight (10%) for clinical observation. Twenty-seven of the 77 HDN were excised; 23 (85%) revealed scar only, and four (15%) revealed residual DN not involving the margin.

CONCLUSION: Routine excision of biopsy-proven dysplastic acral nevi may not be necessary.