Saucerization biopsy of pigmented lesions

Abstract

A variety of skin lesions can clinically resemble malignant melanoma, and bearlyQ melanoma often fails to demonstrate classic bABCDQ morphological features. Therefore, a definitive diagnosis of any pigmented lesion can only be made after histopathologic examination of an appropriate surgical specimen. If a physician is to bdo no harm,Q it is most important to maintain a high index of suspicion when viewing pigmented lesions and to sample enough lesions to encompass as many potentially lethal melanomas as possible without exposing patients to unnecessary surgery. Physicians should sacrifice some degree of diagnostic specificity to maintain a high degree of sensitivity. The decision to perform a biopsy vs a fullthickness excision of a pigmented lesion has a direct bearing on this issue and has been the topic of spirited debates. Biopsies of several types are commonly used because they are simpler to perform, quicker, less costly, and most often heal with excellent cosmetic results. Some physicians have, historically, worried that a biopsy may lead to hematogenous dissemination of melanoma or deeper implantation of tumor and suggest that all questionable lesions should be completely excised. 4 This approach is supported by those who caution that incisional biopsies may be more prone to sampling error that is avoided when a lesion is completely excised. In addition, complete removal of a lesion benefits patients who might be lost to follow-up. Finally, tangential excision specimens of suspicious pigmented lesions that