From the Guidelines
Pigmented nevi should not be removed by shave biopsy due to the risk of incorrect diagnosis and incomplete removal of the lesion. This is based on the most recent and highest quality study available, which recommends excisional biopsies for the removal of pigmented lesions to ensure complete removal and accurate diagnosis 1.
Reasons for Avoiding Shave Biopsy
- Shave biopsies may lead to incorrect diagnosis due to sampling error, and make accurate pathological staging of the lesion impossible 1
- Partial removal of naevi for diagnosis must be avoided, as it may result in a clinical and pathological picture very like melanoma (pseudomelanoma) 1
- Excisional biopsies are preferred to ensure complete removal and accurate diagnosis, especially for flat nevi or those suspected of being melanoma 1
Alternative Methods
- Excisional biopsies that remove the entire lesion with a margin of normal skin are recommended for the removal of pigmented nevi 1
- Incisional or punch biopsy may be acceptable in certain cases, such as the differential diagnosis of lentigo maligna on the face or of acral melanoma, but should only be performed by a skin cancer multidisciplinary team 1
Importance of Accurate Diagnosis
- Accurate diagnosis of pigmented lesions is crucial to determine the appropriate treatment and to ensure the best possible outcome for the patient 1
- The histopathological report must include at least the diagnosis of the melanocytic nature of the lesion and confirmation of its malignancy 1
From the Research
Pigmented Nevi Removal by Shave Biopsy
- Shave biopsy can be used to remove pigmented nevi, but the effectiveness and safety of this method have been debated 2, 3, 4, 5, 6.
- A study published in 2014 found that the scoop-shave technique is a safe and effective method for diagnosing and treating melanocytic lesions, including pigmented nevi 2.
- Another study published in 2011 found that shave biopsy is a safe and accurate method for the initial evaluation of melanoma, with a low rate of complications and accurate diagnosis in 97% of cases 3.
- A 2014 review of dermatology procedures noted that shave biopsy is a common method for removing pigmented nevi, but it may not be suitable for all types of lesions 4.
- A 2023 study found that shave biopsy is the most frequent method of diagnosis of cutaneous melanoma, but it may underestimate the true T-stage of the tumor 5.
- A 2000 study compared conventional excisions with shave excisions for removing melanocytic nevi and found that shave excisions resulted in fewer complications, but recurrences were more frequent 6.
Key Findings
- Shave biopsy can be an effective method for removing pigmented nevi, but it may not be suitable for all types of lesions 2, 4.
- The scoop-shave technique is a safe and effective method for diagnosing and treating melanocytic lesions, including pigmented nevi 2.
- Shave biopsy may underestimate the true T-stage of melanoma, but it can still be used to guide appropriate treatment and definitive wide local excision 5.
- Patients should be informed about the higher rate of recurrences associated with shave excisions 6.