If a shave biopsy on a mole was done, and it happened to be melanoma but was misdiagnosed as benign, would the melanoma grow back in the biopsy site?
Will a Melanoma Grow Back from Shave Biopsy?
Doctor Answers (7)
Will a Melanoma Grow Back from Shave Biopsy
If the lesion was biopsied and then determined to require complete surgical excision, then I would highly recommend that you see your physician for follow-up for complete surgical excision.
Will Melanoma Grow Back After Shave Biopsy
A biopsy, whether shave or excisional, is performed in order to determine whether anything further needs to be done. If the biopsy is read as benign, then generally nothing further needs to be done. If the biopsy is read as malignant or atypical, then generally further surgery is performed. Exactly what is performed is dependent upon what the diagnosis is... e.g. atypical nevus, melanoma in situ, invasive melanoma. If a patient is concerned that the pathologic diagnosis is incorrect, they should get a consultation or second opinion on the biopsy. It is not a good option to wait and see what grows back. A benign lesion may grow back if it is incompletely removed. A melanoma may grow back if it is incompletely removed; however, if a melanoma was originally in the tissue specimend, waiting to see when it grows back may allow some of the melanoma cells to reach deeper and possibly impact one's prognosis. If you have doubt or question, there is no problem getting a second opinion.
Biopsy site of melanoma requires excision
Based on the history that you have provided, you should have the biopsy site excised further. If the biopsy results truly show melanoma, a wide and deep elliptical excision is required to provide a safe margin of removal of remaining cancer cells. Deeper melanomas may require further studies of the lymph nodes. A shave biopsy does not provide adequate margins for melanoma. Leaving a biopsied melanoma untreated may have fatal consequences. Please seek follow-up with a Board certified dermatologist.
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Biopsy Proven Melanoma - Now What?
Biopsies of suspicious moles are often performed by a shave technique. If the biopsy comes back as a melanoma, additional treatment should be performed. At a minimum, this includes re-excising the mole to ensure a clear margin is obtained with no residual melanoma is left behind. Unlike the shave biopsy, the re-excision is performed with a scalpel and the wound is closed with stitches. Depending on how severe your melanoma is, additional tests and procedures, such as a sentinal lymph node biopsy, might be recommended. The chance of your melanoma recurring at the biopsy site or elsewhere, depends on the severity of the melanoma.
Shave biopsy of a melanoma
Suspicious moles are frequently removed by a shave biopsy. If the biopsy report reveals it to be a melanoma, it is necessary to do an excision with suture closure to get clear margins both laterally and deeply so you can be certain that it has been entirely removed. Once this had been done with appropriate margins, the melanoma should not grow back in the biopsy site.
Yes, unless the shave biopsy contained the melanoma
The return of pigment after a shave biopsy usually does not mean that you had a melanoma originally. A shave biopsy, if the entire mole was not taken out, will often lead to what is termed a recurrent nevus. What happens, is that the deeper mole cells ( melanocytes) are now exposed to the sun and gain the ability to pigment. That is why it is important to wear a sunscreen after a shave biopsy.
There are two signs that weigh for a recurrent nevus rather than a melanoma.One is if the pigmentation formed within a few months of the shave biopsy. The second sign is if the pigmentation is within the scar site.
It is important for you to return to the dermatologist who performed the shave biopsy so that he/she either perform a re-excision with a punch or excision technique or at least ask the pathologist to review the slides. I personally, re-biopsy to be conservative and extra cautious.
It is important for the dermatopathologist to be aware of the fact that the mole was previously biopsied. The scar formed from the shave biopsy can distort the melanocytes, making them appear more ominous than they really are.
The shave technique should really be used only in two circumstances. One, if the physician ( and patient) are entirely confident that the mole is benign and that the shave technique will afford the patient a better cosmetic result. The second instance would be under circumstances where the physician is concerned about a lentigo maligna, especially on the face. These can be quite large and a standard biopsy might prove quite disfiguring. Some physicians prefer biopsying only the suspicious areas, while others feel a wide shave excision will encompass the whole lesion. Since a lentigo maligna ( Hutchinson's freckle) is, by definition superficial this would be a reasonable option. Lentigo Maligna is a skin lesion, usually seen on the face of elderly people. If there is invasion into the dermis, the Lentigo Maligna has balefully morphed into a lentigo maligna melanoma. Unlike other melanomas, the Lentigo Maligna Melanoma is associated with chronic sun exposure, like basal cell carcinomas and squamous cell carcinomas.
There are three reasons we dermatologists do not like shave biopsies for suspicious lesions. First, a shave biopsy may leave melanoma cells that are deeper than the shave biopsy cut. This is unusual, but can happen.
Second, it becomes nearly impossible to judge the level of the melanoma. This can be very important both in prognosis and treatment. For instance, whether to perform lymph node biospies or exploration. We would not think of a time consuming and expensive exploration if the level was say Breslow 0.11. However, a Breslow level 3.2 would necessitate a thorough exploration.
Finally, when I am quite suspicious, and the lesion does turn out to be a melanoma. I would rather tell the patient the bad news ( you have a melanoma) with some good news, (we have removed the whole thing). Patients are still referred to a surgical oncologist, plastic surgeon, or general surgeon specializing in melanoma treatment, depending on location. But at least, there is far less anxiety while the patient is waiting for their appointment and more definitive surgery.
Melanoma after shave biopsy
A shave biopsy, rather than excisional biopsy, is problematic when melanoma is suspected. Melanoma is staged based upon the depth or thickness of the lesion, so when it is shaved, you lose the ability to accurately assess the thickness for the purposes of establishing a course of treatment, beyond wide excision, and prognostication. Any melanoma should be treated by wide excision with significant margins. I am curious to know why you think a melanoma might have been misdiagnosed as benign. The pathology slides can be re-reviewed by another laboratory; I personally send all my specimens to a dermatolopathologist who specializes in lesions rather than a general pathology laboratory. Melanoma is a serious disease which can be deadly so, if you have any reason to believe that you did have a melanoma, I would encourage you to seek treatment from a team including a board certified dermatologist and plastic surgeon, who could then determine what further evaluation and surgery might be necessary and whether referral to an oncologist would be appropriate. Best of luck. Dr. K