Dysplastic nevi with severe atypia: Long-term outcomes in patients with and without re-excision.

BACKGROUND: Dysplastic nevi with severe atypia (severely dysplastic nevi [SDN]) are frequently re-excised because of the concern that these lesions may in fact represent early melanoma. Data on long-term follow-up of these patients are limited. OBJECTIVE: We sought to determine the rate of subsequent melanoma development in patients with SDN who underwent re-excision versus those who did not and to determine factors associated with decision to re-excise. METHODS: A retrospective single institutional study was conducted with 451 adult patients (mean age 41.3 years) with SDN biopsied between November 1994 and November 2004, with clinical follow-up of at least 5 years. RESULTS: In 451 patients with SDN, re-excision was performed on 36.6%. Two melanomas were diagnosed in the re-excision specimens. Subsequent metastatic melanoma developed in 7 patients, all of whom had a history of melanoma. Margin comments influenced decision to re-excise. LIMITATIONS: This was a retrospective study at a single institution. CONCLUSION: Re-excision of all SDN may not be necessary.

Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation.

PURPOSE: Our aim was to determine if acetabular component position, femoral offset restoration, or leg-length equality is most important for total hip arthroplasty (THA) stability. METHODS: A matched case (n = 67)-control (n = 247) design and conditional logistic regression model were used to examine risk factors for dislocation in primary THA. RESULTS: When femoral offset was at least 3 mm greater than that of the contralateral hip, risk of dislocation was lower (p = 0.0192). Neither leg-length difference nor acetabular component abduction or version angle was associated with dislocation. CONCLUSIONS: Our data suggest restoring femoral offset is the most important technical factor in preventing THA dislocation.