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There are 2 general patterns of growth of dysplasia in ulcerative colitis (UC), considered flat (endoscopically undetectable) or elevated (endoscopically detectable).1 Elevated lesions are referred to by the acronym DALM (dysplasia-associated lesion or mass). Since the original description by Blackstone et al in 1991,2 it has been recognized that DALMs represent a heterogeneous group of lesions with different natural histories and risks of malignancy.1 DALMs are further subclassified as adenoma-like or non-adenoma like, depending on the gross characteristics of the lesion. Grossly, adenoma-like DALMs represent well-circumscribed, smooth or papillary, nonnecrotic, sessile, or pedunculated polyps that are usually easily removed by routine endoscopic methods, similar to sporadic adenomas. Nonadenoma-like lesions include velvety patches, plaques, irregular bumps and nodules, wart-like thickenings, stricturing lesions, and broad-based masses. These lesions are not typically amenable to removal by colonoscopy.

It is well known that nonadenoma-like DALMs have a high risk (36%–85%) of either synchronous or metachronous cancer.1,–3 However, previous studies that evaluated the natural history and risk of malignancy in UC patients with a nonadenoma-like DALM included lesions in which biopsies were obtained from the surface of the mass and, despite the fact that the biopsy showed only dysplastic epithelium, the underlying carcinoma was either not sampled or not detected until a colonic resection was performed. In contrast, adenoma-like DALMs possess a low risk of malignancy and, as a result, may be treated conservatively by polypectomy and continued surveillance (see below).

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How do Physicians make their choice of therapy to recommend to Patients with IBD?: Classification of DALMs: Treatment
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