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[4 min read] How to biopsy pigmented skin lesions
A recent article published in Australian Doctor warned against shave biopsies for pigmented skin lesions suspicious for melanoma. Below, Professor David Wilkinson offers guidance for the best-practice approach to biopsying these lesions in general practice.
General practitioners can, and should, follow the national guidelines for the diagnosis and treatment of skin cancer. The most up to date version for melanoma is found here.
Regarding the biopsy of pigmented skin lesions, actually the situation is simple and straightforward. If our suspicion is that we are looking at a melanoma, and we want to confirm that. To do so, we must remove the whole lesion for diagnostic purposes, if at all possible. A 2mm excision biopsy of a suspicious pigmented skin lesion will always yield the most accurate result. This is what we should always aim to do.
Partial biopsy of a suspicious pigmented skin lesion is to be avoided wherever possible. However, in some settings this is impossible to do (such as in large facial lesions) and so a shave or punch biopsy (or a combination of these or multiple biopsies) is appropriate.
This is not about cutting corners – it is about doing the best we can under tricky circumstances.
An experienced clinician will, at times, do a shave biopsy on suspicious pigmented skin lesions, but he / she will only do this if the lesion is small and flat. He / she will go deep enough and ensure that the entire lesion is removed for the biopsy.
As always, we should use national guidelines to support our practice. And, as always, we should apply the guidelines to the patient and situation in front of us.
Professor David Wilkinson
Read more from Professor David Wilkinson on recent research:
- Accuracy of computer-aided melanoma diagnosis
- Dysplastic naevi genetic makeup
- What to do when a partial biopsy of a suspected melanoma is performed