Diagnosis of Cutaneous Melanoma

  • The choice of biopsy technique:
    • Varies according to the anatomical site as well as the size and shape of the lesion
  • Particular attention should be placed on the impact of the biopsy on definitive surgical treatment
  • Either an excisional biopsy or an incisional biopsy using a scalpel or punch is acceptable
  • Entire removal of the lesion is generally preferred to allow for accurate pathologic evaluation
  • Punch biopsies:
    • Can be performed for most lesions:
      • Generally, they can be performed when lesions are located on areas where maximum preservation of surrounding skin is important, or
      • Can be completely excised with a punch
    • Punch biopsies:
      • Should be performed at the most raised or darkest area of the lesion to sample the most aggressive area of the potential melanoma
  • Full-thickness biopsy:
    • Into the subcutaneous tissue should be performed to ensure accurate staging of the lesion
  • An excisional biopsy:
    • Allows the pathologist to accurately determine the thickness of the lesion, since the entire lesion is available for evaluation
  • Excisional biopsies:
    • Should be performed when the lesion is too large for a punch but still can be removed without excessive surgical intervention
  • For excisional biopsies:
    • A narrow margin of normal-appearing skin (1 to 3 mm) is taken with the specimen
  • An elliptical incision:
    • Is often used to facilitate closure
  • The biopsy incision should be oriented to facilitate later wide excision (e.g., axially on extremities) and minimize the need for a skin graft to provide wound closure at the time of wide excision
  • Shave biopsy:
    • Is generally discouraged if a diagnosis of melanoma is being considered since incomplete assessment of tumor thickness may result if the deep margin is not cleared
    • If a shave biopsy is performed:
      • A deep shave is preferable
  • In general, I submit all pigmented lesions for permanent section examination and perform definitive surgery at a later time
  • I generally prefer image-guided fine-needle aspiration biopsy as an initial diagnostic maneuver to document nodal or other melanoma metastases:
    • But not to diagnose primary melanomas
Excisional Biospy
Punch Biopsy

#Arrangoiz #CancerSurgeon #Teacher #HeadandNeckSurgeon #SurgicalOncologist #SkinCaner #Melanoma #PunchBiospy #CASO #CenterforAdvancedSurgicalOncology

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