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.

Biopsy

• Patients who have lesions suspected to be melanoma should always be biopsied.
• An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is recommended.
• Shave biopsy is acceptable only when the index of suspicion for melanoma is low.
• The following should be reported when a biopsy is being reported:

• Location
• Regression
• Tumor infiltrating lymphocytes
• Breslow thickness and vertical growth phase
• Histologic ulceration
• Clark level
• Angiolymphatic invasion
• Neurotropism
• Histologic subtype

Approach to Patients with Suspected Melanoma

The following algorithm illustrates the approach to patients with suspected melanoma.

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

Staging