If you have a nevus that exhibits severe dysplasia upon first biopsy with clear margins, do you still re-excise anyway?
I had a nevus removed and the path report came back as severe dysplasia with margin involvement thus further re-excision was recommended. But, I want to know, had the margins been clear upon first biopsy would re-excision still be necessary?
Yes. For severely atypical lesions, the recommended margins are 5mm, not just clean margins. So even clean margins on the biopsy – they most likely would have recommended coming back.
Thank you for the reply Janner. Yes, my path report said that treatment, as if it were melanoma in situ, should be considered. But, I had wondered if it had clear margins initially would you still need the 5mm margin. I suppose in that instance not every dermatologist would recommend further re-excision. However, with margin involvement most would.
Some derms probably won't, but the standard of care is 5mm with any severely atypical lesions. Most biopsies, unless it is excisional, will not satify the 5mm clear margins so will require a WLE.
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