๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Pigmented lesions
Pigmented lesions
The American Academy of Dermatology (AAD) and the National Comprehensive Cancer Network (NCCN) list narrows excisional biopsy as the preferred technique for sampling lesions suspicious for melanoma. Importantly, saucerization, or a scoop-shave technique, is suitable for thin melanocytic lesions and rarely compromises staging,10,11 and indeed, the AAD guidelines themselves include saucerization as a technique to accomplish an excisional biopsy.
In a study of 332 melanoma patients, most diagnostic biopsies had positive margins regardless of biopsy technique, but staging changed in only 8% of patients, of whom 59% had a punch biopsy, 15% an incisional biopsy, 15% a shave biopsy, and 11% an excisional biopsy (P < 0.0001). Treatment recommendations changed in 6% of the patients: 2% after excisional biopsy, 5% after shave biopsy, 18% after punch biopsy, and 18% after incisional biopsy (P < 0.0001).12 These data suggest that scoop-shave technique on an appropriately chosen lesion can be a prudent choice, but punch biopsy should be discouraged.
Another study of 709 patients showed that shave biopsies resulted in more positive deep margins (P < 0.001). Both shave and punch biopsies resulted in more positive peripheral margins (P < 0.001) and a higher risk of finding residual tumor on wide local excision (P < 0.001), but biopsy type did not confer survival advantage or impact tumor recurrence, suggesting that experienced clinicians should be free to choose the most appropriate technique for a given lesion.13 Other authors have published data supporting similar conclusions.14,15
In the setting of lentigo maligna, it is often impractical to remove the entire lesion, and sampling of the lesion may be more appropriate. A broad area of the dermalโ epidermal junction may be demonstrated by a broad, thin biopsy resembling properly cut prosciutto. If the lesion is mottled with many colors, multiple small thin shaves sampling each color may be more appropriate. If a skin crease naturally traverses the area to be sampled, an incisional biopsy can be aligned along the crease.