Fast Five Quiz: How Much Do You Know About Melanomas?

William James, MD

Disclosures

February 18, 2020

According to the most recent guidelines from the National Comprehensive Cancer Network (NCCN), a complete excisional biopsy is preferred. The sample should have a 1- to 3-mm margin of healthy skin and should include all layers of skin and some subcutaneous fat. A full-thickness incisional or punch biopsy of the clinically thickest area of the lesion is acceptable in certain anatomical areas only (palm/sole, digit, face, ear) or for very large lesions.

A shave biopsy may compromise pathologic diagnosis and complete determination of Breslow thickness.

Current recommendations for surgical margins of excision are as follows:

  • In situ lesions: 0.5- to 1-cm margin

  • Lesions ≤ 1 mm in thickness: 1-cm margin

  • Lesions 1.01 to 2 mm in thickness: 1- to 2-cm margin

  • Lesions 2.01 to 4 mm in thickness: 2-cm margin

  • Lesions > 4 mm in thickness: ≥ 2-cm margin

For more on the workup of melanoma, read here.

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