Melanoma biopsy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.
Overview
All patients with suspected melanoma require biopsy. Findings on biopsy may distinguish the sub-type and the stage of melanoma.
Approach to Patients with Suspected Melanoma
The following algorithm illustrates the approach to patients with suspected melanoma.[1]
Suspicious pigmented lesion | |||||||||||||||||||||||||||||||||||||||||||||||
Biopsy | |||||||||||||||||||||||||||||||||||||||||||||||
Inadequate | |||||||||||||||||||||||||||||||||||||||||||||||
Rebiopsy | |||||||||||||||||||||||||||||||||||||||||||||||
Melanoma confirmed | |||||||||||||||||||||||||||||||||||||||||||||||
Breslow thickness | Ulceration status | Mitotic rate | Depth and peripheral margin status | Presence of satellitosis | Clark level for lesions ≤ 1 mm | ||||||||||||||||||||||||||||||||||||||||||
Reassessment with complete physical examination, including neurological exam and lymph node assessment | |||||||||||||||||||||||||||||||||||||||||||||||
Biopsy
- Patients who have lesions suspected to be melanoma should always be biopsied.[1]
- An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is recommended.[1]
- Shave biopsy is acceptable only when the index of suspicion for melanoma is low.[1]
- The following should be reported when a biopsy is being reported:[1]
- Location
- Regression
- Tumor infiltrating lymphocytes
- Breslow's depth and vertical growth phase
- Histologic ulceration
- Clark level
- Angiolymphatic invasion
- Neurotropism
- Histologic subtype
To view the histopathologic characteristic features of all subtypes of melanoma, click here.