MrsPA2u Posted May 17, 2017 Share Posted May 17, 2017 What is the standard across the board when a patient presents with a clinically suspicious PIGMENTED LESION (whether macular or papular)? Should a biopsy be performed first to confirm its pathology OR should pigmented lesions be fully excised PERIOD without need for an initial biopsy? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 18, 2017 Administrator Share Posted May 18, 2017 Do whatever procedure is best (cosmetically, etc.) for the situation assuming it's NOT melanoma, and then make sure to get the sample to pathology promptly. If it IS melanoma, your nice biopsy site is going to get completely subsumed in the wide excision a board-certified surgeon will do as soon as possible after diagnosis. ... And that still may not be enough. Lost a 35 year old patient last year to a melanoma, even though I had done everything right and promptly. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 18, 2017 Moderator Share Posted May 18, 2017 depends on size if you can excise and clean margins due to small lesion then due so if larger lesion - just Bx Link to comment Share on other sites More sharing options...
brooks23 Posted November 12, 2018 Share Posted November 12, 2018 Did anything ever come of this? In my practice, we only do excisional biopsies on lesions suspicious for melanoma. Everything else is a shave to begin. Of course, there are clinical situations where the lesion is so large that a smaller shave is appropriate even when suspecting a large lentigo maligna, etc. It sounds like your SP wants to capitalize on the increased collections that come from excisions vs shaves, despite it not necessarily being clinically warranted. Curious if anything changed in your practice, or if you're still doing lots of excisions. Link to comment Share on other sites More sharing options...
PA-C Posted November 14, 2018 Share Posted November 14, 2018 Where I work the protocol is to do a shave bx or punch bx for diagnosis and escalate to excision or MOHS depending on the path report. Sounds like your CP is jumping straight to excision for monitary gain. Link to comment Share on other sites More sharing options...
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