Management of dysplastic nevus by Italian dermatologists: a survey of the Italian Association of Hospital Dermatologists (ADOI)

Dysplastic nevus (DN) represents a diagnostic and management challenge due to low interobserver agreement among pathologists and the absence of universally accepted guidelines. This nationwide cross-sectional survey aimed to investigate the current surgical management of DN among Italian dermatologists and to explore the use of diagnostic tools. A structured questionnaire was distributed to members of the Italian Association of Hospital Dermatologists (ADOI) and included four sections: (1) demographic and professional information; (2) use of diagnostic instruments for the evaluation and follow-up of pigmented lesions; (3) surgical practices and communication with dermatopathologists; and (4) clinical and therapeutic management of DN stratified by low-grade or high-grade dysplasia and by margin status. A total of 190 dermatologists (response rate: 11.9%) completed the questionnaire. Most respondents opted for observation in cases of low-grade DN with clear margins (97.9%), while 68.9% recommended re-excision when margins were involved. For high-grade DN with clear margins, 64.2% preferred observation, whereas 35.8% performed re-excision. In cases of high-grade DN with positive margins, nearly all respondents (96.3%) indicated re-excision. Dermoscopy was universally used (99.5%), video-dermoscopy was applied by 77.4% of respondents, and reflectance confocal microscopy (RCM) by only 7.4%, with higher adoption in Central Italy and among mid-career dermatologists. Surgical removal was most often performed by elliptical excision (76.3%). The answers revealed substantial heterogeneity in management practices, particularly for high-grade DN with negative margins, and limited uptake of advanced diagnostic tools. These results underscore the need for updated, evidence-based national guidelines to standardize care, optimize resource allocation, and reduce unnecessary surgical procedures.