Atypical lesions should be excised
Atypical lesions require excisional biopsy. The depth and architecture of the lesion, if melanoma, cannot be determined by shave biopsy, and both treatment and prognosis depend on those characteristics.
These guidelines derive from well-designed, nonexperimental descriptive studies.5 However, a recent retrospective study compared the Breslow depth determination of 4 different biopsy techniques, performed by experienced dermatologists, with the subsequent depth on definitive surgery for melanoma. This study found that superficial shave, deep shave, and punch biopsy predicted the Breslow depth 88% (95/108) of the time.6 As expected, excisional biopsy predicted the depth 100% (30/30) of the time. The location of the biopsy sites were not reported. The choice of biopsy was influenced by the suspicion of melanoma; thin (< 1 mm) melanomas were more likely to be superficially shaved than deep-shaved or punched.
Recommendations from others
Guidelines on nevocellular nevi from the American Academy of Dermatology recommend a simple excisional or incisional biopsy; they do not discuss the method of removal for benign appearing facial lesions.7
The UK Guidelines for the Management of Cutaneous Melanoma recommend that suspicious lesions be excised completely (excisional biopsy) and sent for confirmatory histopathological examination.5 A biopsy that transects the depth of the lesion (for example, superficial shave biopsy) should be avoided because histological depth of invasion is the basic criterion for staging and shave biopsy makes the staging impossible in some cases.