From the Guidelines
A skin biopsy of the left hand that does not represent the whole lesion should be completely excised with a clinical margin of 2 mm of normal skin and a cuff of fat to ensure accurate diagnosis and staging, as recommended by the revised U.K. guidelines for the management of cutaneous melanoma 2010 1. This approach is crucial because partial sampling can lead to incorrect diagnosis due to sampling error, making accurate pathological staging of the lesion impossible, as highlighted in the guidelines 1. Some key points to consider in the management of such lesions include:
- The importance of complete excision to confirm the diagnosis by examination of the entire lesion, allowing subsequent definitive treatment to be based on Breslow thickness 1.
- The need to avoid diagnostic shave biopsies and partial removal of naevi for diagnosis, as they may lead to incorrect diagnosis and needless anxiety 1.
- The role of incisional or punch biopsy in specific circumstances, such as the differential diagnosis of lentigo maligna on the face or of acral melanoma, but only within the skin cancer multidisciplinary team (MDT) 1.
- The requirement for full clinical details to be supplied on the histopathology form, including history of the lesion, relevant previous history, site, and differential diagnosis, to ensure accurate reporting of melanocytic lesions 1.
From the Research
Skin Biopsy of the Left Hand
- The sample not representing the whole lesion may lead to inaccurate diagnosis or incomplete information about the lesion.
- According to 2, skin biopsy is a safe and easy procedure, but complications such as bleeding, infection, and scarring may occur, especially when performed in an out-patient setting with basic infrastructure.
- The choice of biopsy type depends on the suspected disease pathology and lesion location, as stated in 3 and 4.
Biopsy Techniques
- There are various methods of performing skin biopsy, including shave biopsy, punch biopsy, and excisional/incisional biopsy, as mentioned in 3 and 4.
- The decision to perform a biopsy and the type of biopsy technique to use should be based on the suspected disease pathology and lesion location, as explained in 5.
- For hand, wrist, and forearm tumors, three biopsy methods are commonly used: open biopsy, fine needle aspiration, and core needle biopsy, as described in 6.
Considerations for Skin Biopsy
- It is essential to consider the potential pitfalls and complications of skin biopsy, such as bleeding, infection, and scarring, and take steps to avoid them, as discussed in 2 and 5.
- The choice of biopsy technique should be based on the suspected disease pathology and lesion location, as well as the patient's individual needs and circumstances, as stated in 3 and 4.