Case Number : Case 1966 - 12 Dec 2017 Posted By: Uma Sundram

Lichen planus like keratosis (LPLK)

Junctional dysplastic nevus

Agreed. Junctional dysplastic nevus.

Agree. Mildly dysplastic nevus 

Agree, mildly dysplastic naevus. Management at clinical discretion.

Yes, mildly dysplastic nevus; I would not argue too much with moderate dysplasia. In the States, clinical approach to these lesions vary regionally. I am in an 'aggressive' part of the country now where these are often re excised when they approach margins.

Aggressive, paranoia, perverse incentive, sub-optimal competence, etc or all of the fore-mentioned.   If they were worried clinically in the first place they should have excised it with a clear margin thus avoiding all the hassle. If there was no clinical worry why biopsy? In UK we pathologists can be quite "passive aggressive" as we have a different pecuniary relationship to clinical colleagues (particularly for NHS work) although we are creeping away from this and can be "led" by clinical colleagues who like to do extra procedures!  I generally don't advise re-excision for lesions I called mildly dysplastic (hence "clinical discretion, i.e. based on the original clinical features which can be arbitrary for small / superficial lesions) but it would be so much simpler for all concerned (patient in particular) the clinical colleagues did not do tight and superficial shaves of small and mildly atypical clinical lesions. To me it is grossly sub-optimal if not mal-practice.