Saucerization is also the preferred biopsy type for basal cell and squamous cell carcinomas (SCCs). Studies have shown tumor depth is the most important factor in predicting metastasis of SCC, as well as tumor relapse rate, making accurate identification of the depth of the tumor important for both management and prognosis.12,13 Determining the thickness of the SCC is important for guiding management. SCC in situ is more amenable than invasive SCC to topical therapy or electrodesiccation and curettage.
What you’ll need. FPs can perform saucerization quickly and easily in the office during a standard 15-minute visit. Of course, it is essential to have all the necessary materials available. The key materials needed are lidocaine and epinephrine, a sharp razor blade such as a DermaBlade, and something for hemostasis (aluminum chloride and/or an electrosurgical instrument). Cotton-tipped applicators to apply the aluminum chloride and needles and syringes to administer the local anesthetic are also needed. (See JFP’s Watch and Learn Video on shave biopsy.) A quick saucerization eliminates the need for the patient to return for an elliptical excision and prevents a delayed diagnosis that can occur as a result of a long wait to see a dermatologist.
As a final note, the pathology order form should be completed with information on biopsy type, clinical presentation, differential diagnosis, and whether or not the full lesion was excised.
MYTH #2
A wide excisional biopsy is required for a suspected melanoma.
While complete excision of the entire tumor does allow the pathologist to evaluate the entire growth, wide (>3 mm) margins on the initial biopsy are not necessary. In fact, there are potential disadvantages to full excisional biopsy.
For example, seborrheic keratoses and other benign growths can mimic melanoma. Neither the physician nor the patient wants to learn that a large elliptical wound was created for a growth that turned out to be a benign seborrheic keratosis. Saucerization provides the pathologist with the entire lesion, and the resulting shallow wound heals as a round scar that is most often acceptable to patients.10,11,14 In addition, excisional biopsies carry a higher risk of infection than does saucerization.
Even when the index of suspicion is high for melanoma, a wide margin is not indicated. NCCN guidelines suggest that the margins around a suspected melanoma on initial biopsy not exceed 3 mm to avoid disrupting the accuracy of an SLNB (FIGURE 2).3
