Hole punch.

Responsible patients undergoing routine skin exams are often saddled with a common good news / bad news scenario. First they learn that path on the shave biopsy didn’t reveal cancer (hooray!), but it did reveal “positive margins” on a dysplastic nevi requiring a bigger, uglier excision (hey, wait a minute…). This skin-saving retrospective study looked at patients whose dermatologists had the gumption to observe such positive margins on 467 moderately dysplastic nevi. At a mean follow-up of 7 years, the cumulative number of cutaneous melanomas occurring at these 467 biopsy sites was: zero. But these patient aren't out of the woods just yet: among the 191 patients with prior history of dysplastic nevi, over one-third did develop melanoma in a separate site. TBL: Moderately dysplastic nevi clinically behave more like surrogates than precursors of developing melanoma. | Kim, JAMA Dermatol 2018