to biopsy or excise....THAT IS THE QUESTION??

[MrsPA2u]

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?

 

 

 

[rev ronin]

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.

[ventana]

depends on size

 

if you can excise and clean margins due to small lesion then due so

if larger lesion - just Bx

[brooks23]

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.

[PA-C]

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.