Retrospective multicenter study on severely dysplastic melanocytic nevi: evaluating the need for re-excision and the risk of recurrence or progression

Severely dysplastic melanocytic nevi (SMD) are histologically challenging lesions with no consensus on optimal management. While complete excision is widely recommended, the necessity of additional re-excision remains debated. This retrospective, multicenter observational cohort study evaluated the risk of recurrence and disease progression in patients with SMD by comparing those who underwent a single complete excision to those who underwent a secondary widening procedure with 5 mm margins. A total of 226 patients (230 SMD lesions) were included, with diagnoses based on the 2018 World Health Organization (WHO) criteria. Among them, 13.5% underwent re-excision despite clear margins, while 86.5% were followed clinically. Over a minimum 5-year follow-up period, no patient in either group experienced recurrence at the excision site or progression to melanoma. These findings suggest that complete excision with clear margins is sufficient for managing SMD, with no added benefit from routine re-excision. Avoiding unnecessary surgical procedures could reduce patient anxiety, healthcare costs, and surgical morbidity. Given the lack of standardized guidelines, further prospective studies are needed to refine clinical decision-making for SMD management.