Comment on margins for benign nevi: yes or no? Discuss.

[dodobird13]

Anecdotal evidence has led me to believe that many of my clinicians will re-excise many completely benign entities should one comment on a positive margin. I stopped doing so and have heard no complaints, but am curious how others manage such cases.

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[caffeinegirl]

I always comment on margins.. but do so like this:

"Intradermal melanocytic nevus, present at lateral edge and base of biopsy specimen"

This doesn't use the term "margin", and still tells them that the lesion hasn't been completely removed. I have never had a clinician take out a melanocytic nevus, which was called such without mention of dysplasia/atypia. I think it's good practice, at least with melanocytic lesions, to mention what the edges of the margin look like. So, if the site repigments, then at least you know that you didn't get around it.

For a paper regarding practices on margin reporting in melanocytic lesions, see http://www.ncbi.nlm.nih.gov/pubmed/20846568
Practices vary greatly regarding reporting on biopsies. I think this is a regional effect, and that talking to your clinicians can help. I also tailor my reports to the dermatologist/clinician. As for benign non-melanocytic entities, I do not mention margins on hemangiomas, but do so on almost everything else.

J Am Acad Dermatol. 2010 Oct;63(4):661-7.
Histologic processing and reporting of cutaneous pigmented lesions: recommendations based on a survey of 94 dermatopathologists.
Kolman O, Hoang MP, Piris A, Mihm MC Jr, Duncan LM.

 

[deleted314957]

i am not a derm path but i know a bunch and do about 25 derm office FS per week (easy money for no good reason, NONE of them melanocytic). It is my understanding
(and I have seen some) that incompletely excised b9 melanocytic nevi that recur can have a somewhat alarming appearance and a HX of prior (incomplete) excision explains the situation.

As I said---I am not a derm path.

 

[zao275]

Agree with caffeinegirl and mikesheree. I also like the comment of the lesion being "at the section edges" rather than "margins" (a word that should be avoided for biopsy specimens, or so my mentors have taught me).

 

[dodobird13]

The above comments all seem reasonable to me, and that is how I operated when I first started practicing. Then the phone calls started coming: do I need to re-excise? Is this malignant? What do I do? Or worse, we'd just get a re-excision of a completely banal nevus. So I dropped the "margin" comment on the majority of my benign entities, but never heard a peep from the masses (who generally never hesitate to call about the most minute complaints they may have). I think I'll reintroduce it with more delicate language avoiding the term "margin" altogether and see what happens. Many thanks, everyone.