Skin tags on eyelids betadine12/11/2023 The American Academy of Dermatology Guidelines/Outcomes Committee for Cutaneous Melanoma and the National Comprehensive Cancer Network recommend initial excision with 1- to 3-mm margins for suspect lesions 3, 4 other biopsy methods can be used, including punch and full-thickness incisional biopsies in specific anatomic areas or for large lesions that are difficult to excise. 1, 5 Lesions that fulfill some or all of the ABCDE criteria can be biopsied. 5 Factors to identify patients at high risk of malignancy include a personal or family history of melanoma, fair complexion, presence of multiple pigmented nevi, a history of numerous severe sunburns, and advanced age. ![]() A thorough history for risk factors should be obtained, and the lesion should be inspected using the ABCDE criteria (asymmetry, border, color, diameter, evolution Table 3 22, Figure 3), the Glasgow 7-point checklist, and the “ugly duckling” sign (i.e., one lesion that is distinct from others). ![]() 14, 16Ī saucerization, punch (for lesions smaller than 4 mm), or elliptical excision biopsy may be performed when a lesion is suspicious for melanoma. 18, 21 Limitations of the punch biopsy are that it may not provide a wide enough sample in suspect pigmented lesions (because of the narrow, deep nature of the specimen 13), which in turn may affect tumor staging and prognosis. 1 Secondary intention healing and suturing have similar cosmetic results for lesions 1 to 4 mm in diameter. 2, 5 The site should be closed with simple interrupted or vertical mattress sutures to provide the best cosmetic result ( Table 2 18 – 20 ). 6 Bullae should be biopsied perilesionally if neoplasm is suspected, the biopsy should be performed on the thickest area of the lesion that can be obtained with narrow margins. Punch biopsies may be used for lesions that require dermal or subcutaneous tissue for diagnosis, including inflammatory or bullous lesions, dysplastic or complex nevi that are too large to be excised, panniculitis, and scalp or hair follicle biopsies. 1 Punch biopsies can be excisional or incisional, depending on the size of the lesion and the type of tissue that needs to be obtained. In a punch biopsy, a skin punch instrument with a circular blade extends through to the subcutaneous fat to obtain a cylindrical specimen. Shave biopsy on the foot is preferable to a technique requiring sutures because of excessive tension. 2 Keeping the area covered and moist for at least one week may decrease scarring. 9 Hemostasis is usually obtained with aluminum chloride 20% solution silver nitrate or Monsel solution (ferric subsulfate) may be used instead, but staining can occur. This procedure yields a flat, thin specimen of combined epidermis and upper dermis (less than 1 mm). 15 blade), although many physicians prefer a Dermablade, a double-edged razor blade, or scissors 1, 2, 6, 8, 9 ( Figures 1 and 2). 2, 6, 7 A superficial shave removes a thin disk of tissue, typically by scalpel (generally a no. 2, 6 This type of biopsy is not appropriate for suspicious pigmented lesions. ![]() ![]() A superficial shave biopsy is used for lesions that are predominantly epidermal without extension into the dermis, such as warts, papillomas, skin tags, superficial basal or squamous cell carcinomas, and seborrheic or actinic keratoses.
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