Dysplastic Naevus Management — SCE Dermatology MCQ

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ModerateSkin CancerDysplastic Naevus ManagementSCE Dermatology

A 55-year-old woman has a melanocytic naevus excised. The pathologist reports it as a 'dysplastic naevus' with moderate architectural and cytological atypia, completely excised. Does she need wider re-excision?

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Correct answer: D — No — a completely excised dysplastic naevus with moderate atypia does not require re-excision; clinical surveillance is appropriate

A completely excised dysplastic (atypical) naevus with moderate atypia does NOT require wider re-excision. BAD and NICE guidelines do not recommend routine re-excision of completely excised dysplastic naevi. The patient should be enrolled in clinical surveillance (appropriate to their overall melanoma risk — considering total naevus count, family history, and personal melanoma history). Only severely dysplastic naevi with positive margins may warrant re-excision or close monitoring. The term 'dysplastic naevus' remains controversial — some pathologists prefer 'naevus with architectural disorder and cytological atypia'. The key management point: complete excision = adequate; incomplete excision of severely dysplastic naevi = consider re-excision.

Reference: BAD 2017 Melanoma; WHO Melanocytic Tumours