› Forums › General Melanoma Community › 6 primaries and counting . ..?’s on shave vs punch
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stars.
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- November 11, 2015 at 12:02 am
I am now up to 6 primaries. Besides that, I am producing more lesions at an incredible rate lately . Depending who I see,the opinion varies on what is the best biopsy method . My surgeon prefers punch,while most of the dermatologists have performed shave. I know most of what I've read here suggest punch. One thing I don't fully understand , is if on a large lesion I get the punch,could the area punched be ok,while the other part of it be malignant ?
Thanks in advance for any help,
Aloha , Bob
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- November 11, 2015 at 12:21 am
If the punch isn't large enough to remove the entire lesion, then a deep shave or excisional may be the way to go. My derm actually did a punch on one lesion to remove the most suspicious part and then did a conservative excision to remove remaining pigment. Not a standard technique but he no longer does shaves on me after shaving my last melanoma (although with clean deep margins).
It's unlikely that what is left behind on a punch would be melanoma if the punch material isn't – they tend to punch the center and/or most suspicious portion. The only thing wrong with a shave biopsy is if it bisects a lesion. If the derm goes deep, then that should be ok. Truthfully, the 0-2mm depth is the only time a lesion really screws up staging even though some info may be lost in deeper lesions — always nice to know the exact depth but it changes nothing over 2mm. So if your docs prefer shaves (and your ok with that), there isn't really a problem with that as long as they go deep. I have shaves because for me, they hurt more healing. But I don't have tons of biopsies so you are in a different place than I am.
Cheers!
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- November 11, 2015 at 12:21 am
If the punch isn't large enough to remove the entire lesion, then a deep shave or excisional may be the way to go. My derm actually did a punch on one lesion to remove the most suspicious part and then did a conservative excision to remove remaining pigment. Not a standard technique but he no longer does shaves on me after shaving my last melanoma (although with clean deep margins).
It's unlikely that what is left behind on a punch would be melanoma if the punch material isn't – they tend to punch the center and/or most suspicious portion. The only thing wrong with a shave biopsy is if it bisects a lesion. If the derm goes deep, then that should be ok. Truthfully, the 0-2mm depth is the only time a lesion really screws up staging even though some info may be lost in deeper lesions — always nice to know the exact depth but it changes nothing over 2mm. So if your docs prefer shaves (and your ok with that), there isn't really a problem with that as long as they go deep. I have shaves because for me, they hurt more healing. But I don't have tons of biopsies so you are in a different place than I am.
Cheers!
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- November 11, 2015 at 12:21 am
If the punch isn't large enough to remove the entire lesion, then a deep shave or excisional may be the way to go. My derm actually did a punch on one lesion to remove the most suspicious part and then did a conservative excision to remove remaining pigment. Not a standard technique but he no longer does shaves on me after shaving my last melanoma (although with clean deep margins).
It's unlikely that what is left behind on a punch would be melanoma if the punch material isn't – they tend to punch the center and/or most suspicious portion. The only thing wrong with a shave biopsy is if it bisects a lesion. If the derm goes deep, then that should be ok. Truthfully, the 0-2mm depth is the only time a lesion really screws up staging even though some info may be lost in deeper lesions — always nice to know the exact depth but it changes nothing over 2mm. So if your docs prefer shaves (and your ok with that), there isn't really a problem with that as long as they go deep. I have shaves because for me, they hurt more healing. But I don't have tons of biopsies so you are in a different place than I am.
Cheers!
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- November 11, 2015 at 9:04 pm
Bob
Perhaps my experiences can help you here.
My first biopsy was a proper excision with 2mm margins – melanoma in situ – went on to have a 0.5cm WLE
My second two biopsies were punch biopsies (or so my derm says). Both were done at my request as the derm was not particularly bothered by either lesion.
One came back 0.33mm SSM, already with clear margins – went on to have a 1cm WLE
The other – and this is the interesting one – came back as severely dysplastic and margins not clear, thus requiring a 2mm excision. To make things clearer, this was a dark spot, about 0.5cm, surrounded by a smattering of very light brown speckly pigment. The doctor punch biopsied the dark spot, and that's what came back severely atypical. The 2mm excision was done… and guess what? Either some small remnant of the dark spot, OR the pale speckle, OR both, were 0.15mm SSM. So yes, another 1cm WLE there as well.
The moral of my story is: unless the punch biopsy has full and clear margins, I would always go for an excision. In my case, an excision would have diagnosed the 0.15mm earlier (only by weeks, but still) AND removed it fully first time around, which as a melanoma patient I find more comforting than having not clear margins.
Derms prefer shave and punch because they are quick – no stitches. But Australian guidelines suggest excision only for suspected melanoma. That said, even after my experience, that dr still did punch biopsies on me (but with a larger punch to get clearer margins. I guess the main thing is: the margins MUST be clear/lesion fully excised with no remaining pigment.
Stars
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- November 11, 2015 at 9:04 pm
Bob
Perhaps my experiences can help you here.
My first biopsy was a proper excision with 2mm margins – melanoma in situ – went on to have a 0.5cm WLE
My second two biopsies were punch biopsies (or so my derm says). Both were done at my request as the derm was not particularly bothered by either lesion.
One came back 0.33mm SSM, already with clear margins – went on to have a 1cm WLE
The other – and this is the interesting one – came back as severely dysplastic and margins not clear, thus requiring a 2mm excision. To make things clearer, this was a dark spot, about 0.5cm, surrounded by a smattering of very light brown speckly pigment. The doctor punch biopsied the dark spot, and that's what came back severely atypical. The 2mm excision was done… and guess what? Either some small remnant of the dark spot, OR the pale speckle, OR both, were 0.15mm SSM. So yes, another 1cm WLE there as well.
The moral of my story is: unless the punch biopsy has full and clear margins, I would always go for an excision. In my case, an excision would have diagnosed the 0.15mm earlier (only by weeks, but still) AND removed it fully first time around, which as a melanoma patient I find more comforting than having not clear margins.
Derms prefer shave and punch because they are quick – no stitches. But Australian guidelines suggest excision only for suspected melanoma. That said, even after my experience, that dr still did punch biopsies on me (but with a larger punch to get clearer margins. I guess the main thing is: the margins MUST be clear/lesion fully excised with no remaining pigment.
Stars
-
- November 11, 2015 at 9:04 pm
Bob
Perhaps my experiences can help you here.
My first biopsy was a proper excision with 2mm margins – melanoma in situ – went on to have a 0.5cm WLE
My second two biopsies were punch biopsies (or so my derm says). Both were done at my request as the derm was not particularly bothered by either lesion.
One came back 0.33mm SSM, already with clear margins – went on to have a 1cm WLE
The other – and this is the interesting one – came back as severely dysplastic and margins not clear, thus requiring a 2mm excision. To make things clearer, this was a dark spot, about 0.5cm, surrounded by a smattering of very light brown speckly pigment. The doctor punch biopsied the dark spot, and that's what came back severely atypical. The 2mm excision was done… and guess what? Either some small remnant of the dark spot, OR the pale speckle, OR both, were 0.15mm SSM. So yes, another 1cm WLE there as well.
The moral of my story is: unless the punch biopsy has full and clear margins, I would always go for an excision. In my case, an excision would have diagnosed the 0.15mm earlier (only by weeks, but still) AND removed it fully first time around, which as a melanoma patient I find more comforting than having not clear margins.
Derms prefer shave and punch because they are quick – no stitches. But Australian guidelines suggest excision only for suspected melanoma. That said, even after my experience, that dr still did punch biopsies on me (but with a larger punch to get clearer margins. I guess the main thing is: the margins MUST be clear/lesion fully excised with no remaining pigment.
Stars
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