Evaluation of surgical margins in melanocytic lesions: a survey among 152 dermatopathologists

Although guidelines are established for reporting tissue specimens of melanomas, such guidelines are not available for reporting surgical margins of benign melanocytic lesions.

We surveyed 582 members of the American Society of Dermatopathology via a web-based questionnaire to evaluate the practice of reporting surgical margins in melanocytic lesions. We were especially interested if the evaluation of margins differs depending on the surgical technique used (shave, punch, and excision) and on the type of melanocytic lesion encountered.

One hundred and fifty-two surveys (26.1%) were returned. Only 32.2% of the dermatopathologists comment routinely on margins of shaved melanocytic nevi and only 33.6% report margins in punch biopsies. More dermatopathologists (57.2%) routinely evaluate excision specimens of melanocytic nevi for margins but still almost half of the survey participants do not report margins in such a common clinical scenario. In contrast, routine evaluation for margins in excised melanomas is high (93.4%). Participants who use the terminology of dysplastic nevi evaluate margins more often and the reporting correlates with the degree of dysplasia. Asked for the terminology used to comment on surgical margins in melanocytic lesions, we observed a great variability in language.

Although clinicians commonly request margin evaluation in melanocytic lesions, dermatopathologists often seem to be reluctant to do so depending on the type of procedure used to remove the lesion. There is a great variability in practice and terminology of when and how to report surgical margins in melanocytic skin lesions.