DigitalCommons@PCOM

Modified Excisional Biopsy Technique for Confirmed or Highly Suspected Melanomas

Suwanee, GA

There are a variety of biopsy techniques for sampling confirmed or highly suspicious melanomas, including excisional, scoop-shave or “saucerization”, shave, and punch biopsy. Herein, we present a case in which a combination approach of saucerization and excisional biopsy was used for a patient with an inadequately sampled melanoma. In the literature, excisional biopsy remains the gold standard for diagnosing melanoma. This technique is accomplished with a full-thickness, fusiform removal of the lesion with a scalpel to the level of adipose tissue (2). The drawback to this technique is the slightly distorted anatomy that can occur during wound closure. Albeit rare, residual melanoma after an excisional biopsy is associated with increased mortality. Because of the nature of this technique, the entire length of the scar will be treated as a tumor, making re-excision more challenging and may lead to extensive scarring (3). The saucerization technique is another modality useful in sampling atypical pigmented skin lesions and is accomplished by using a bendable, curved blade which extends into the deeper dermis. This method is typically reserved for smaller lesions due to fears of incomplete removal or transection of the deeper base, which may affect tumor staging and management. (1) A shave biopsy is performed with a flat blade or razor and results in a partial-thickness sample. This modality is often reserved for more superficial lesions of the skin, such as suspected lentigo maligna (2). A punch biopsy is performed with a round punch tool penetrating the subcutaneous fat layer. The size limitation for this method should be considered as the largest tool available is 10 millimeters; thus, the lesion to be sampled should be 6 mm or less (2). Multiple “scouting” punch biopsies are sometimes used for sampling larger lesions but do not allow for examination of the entire lesion.