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View Full Version : For those of you who know dermatology - why are shave biopsys still done?


irisrose
10-28-2005, 08:18 AM
I went a few days ago and had my "spot" removed. I never saw this derm before, I think he's new to the practice. Anyway, he quickly looked at it and said it was "some warty thing" and he could freeze it off. I told him I would prefer if he remove it as my sister had melanoma. He agreed, but only did a shave biopsy. I've read on here from several people to never allow a shave biopsy. So I wondered why exactly. After some reading, I found that shave will interupt the diagnosing of depth if the lesion is melanoma. I also read that shaves should never be used if melanoma is suspected.

So, my question is, if not even the most trained eye can be 100% certain which moles are melanoma and which are not, why are shave biopsys ever done on a mole? Shouldn't every mole or pigmented lesion be removed by excision only? Aren't these doctors in the dermatology field who do shaves on moles being negligent in the event that a mole truly is melanoma?

Just curious about this issue.

Thanks!!

lidia09
10-28-2005, 11:34 AM
Hi Irisrose
I've had a malignant melanoma in the past, also had a mole curetted off. The curetted one, like yours was a warty looking thing. It was itchy & bleeding but from experience, my doctor reckoned it wasn't malignant & he was right. Healing time was so much faster than all the other benign ones I've had removed by excision. Even if the mole is indeed a melanoma, you'd still need to go back for a wider excision, shaved or excised. I had a huge V shaped chopped out after having my melanoma excised first time round.

Don't know about the depth thing though. They'd still have a pretty good idea as to whether or not it was likely to spread from the second excision I'd reckon. I'm no expert though - just speaking from having had quite a few moles removed.
:)

Lidia

BonBe
10-29-2005, 05:39 AM
If MM is suspected then a excisional is the best way to go. So what if we have the scars at least we are alive!!! (just not that important to me) however, if he won't do a excisional, then a punch biopsy is next best. Never a freeze or shave and I do not know why they are still done, unless they know for 100% it is not cancerous.

Staging is one of (if not the most) critical steps in the post surgical care and treatment regime for MM. If you were dx'd as stage 1 then followup at what ever your oncologist suggests. If stage 2 then more, and so on and so on up the ladder to stage 5. it needs to be staged in order to set you on the path of treatment.

Not to be confused with 'clarks level' which is not the 'stage at which you are' for example, I am stage 2 clarks level 3 all done through the excisional biopsy, and of course more mm was found at the bottom (my lesion was rather thick) thus I had a WLE which needs a 5cm margin all around. This was decided from the orignal pathology from the excisional biopsy I had in the first place.

Bonnie

irisrose
10-29-2005, 08:07 AM
Through much of my reading, I have actually found that punch is even less reliable for diagnosing melanoma. Because it takes just a small punch in the thickest part of the lesion, the melanoma could actually be next to that mole and not in the mole itself. So it would be possible to not get the melanoma cells in a punch. I've read that if a deep shave is performed getting the breadth of the lesion, it's almost as good as excision. I don't believe mine was a deep shave, but it looks like he took it all off. It was pretty small.

I just was wondering why they even do them. No doctor can be certain without a doubt that a mole isn't melanoma. We've read enough stories of people being diagnosed and even their derm was surprised. So if they aren't God and know what lurks under that mole, then why isn't shave and punch biopsys discouraged throughout the dermatology field? Seems a little negligent to me.

Thanks for the replys.

BonBe
10-29-2005, 08:51 AM
Yes my surgeon (plastic surgeon) automatically does the excisional biopsy. My mole was 4.00mm thick, and he was (as was my family doctor) totally shocked that it was MM.

I go to my oncologists every 3 months now for 3 years and then every six months then on to every year. With MM it is so nasty...... not obvious at all, and can hide for many years before (or never) resurfacing. My worst fear now is mets to anywhere.

The local hospital where I had the WLE are not equipped to do the SNB so that was not performed, much to the dismay of the cancer hospital I now go these every 3 months.

Plus full body checks at my dermatologist every three months. Not to mention the many CT scans I have had to have this past year.

I never sunbathed, in fact I always sought the shade, but was burned as an infant, and of course at my age, when we were kids we played outside all the day long. I do not understand the young and not so young people who sun worship or use tanning salons all for the sake of what?

SIGH!

Tauri79
10-29-2005, 11:41 AM
Irisrose,

I'm glad to hear that you have finally had a biopsy on the mole that was worrying you.

The simple truth is that the lesion you had removed was a small one and that a shave biopsy was probably all that was needed.

You will get a result from this. And if (and it's IS still an if) the mole turns out to be a melanoma then you will have to go back for a wider excision anyway.

Have faith. We all hear the stories about doctors missing things. It happens. They are human. But there comes a point that you have to just believe them. They are highly trained and many have worked in the field for many years.

The truth is the 'misses' are not the norm. They are the exception. For every horror story you hear there are thousands more patients that are fine.

Irisrose, have a little faith in your doctor. What and see what the result is first.

Shave biopsies do have their place in dermatology.

Ga Lady
10-29-2005, 04:09 PM
Tauri is right. I too work for a derm and well...we do alot of shaves. My melanoma was a shaved biopsy but the depth of the melanoma was exactly the depth of the melanoma. .80 in Breslow...and was a Clark IV. I am only doing 3 month follow ups and just had a Chest CT done yesterday and I am hoping that will be ok...Then on to an MRI next Friday on the arm that Mel because of this funky looking space on the bend of my arm. The derm doesn't think it's anything and the oncologists doesn't either but their doing it for their peace of mind and mine too! So ya'll pray that my results turn out good. See...I still worry too! And I work for my derm. You can SIT and SLEEP at the Dr's office and not prevent mel...but it's just one of those things that we have to remember we've had and always get follow ups!

Also my derm does pretty deep shaves too...Like over the 1 mm deeep thing...so...that tells alot also.!

irisrose
10-30-2005, 07:49 AM
Thanks for answering.

The reason I had asked about shave biopsys was much of what I've read about that type of biopsy and melanoma. I just wondered why they are still done on any skin lesion if it makes it difficult for the pathologist to stage the melanoma.

I know that because mine was so small that he got all of it with the shave. But I still just wanted to question you guys on the reasoning for it. Like the internet with so many topics, you can find info for one side, but not always the practical, hands on info for the other side.

Thanks a lot! I'll post back and let everyone know what the results are.

P.S. GaLady - I'll be sending good thoughts your way. I hope all of your scans and tests turn out fine!! Good luck!