Is a Punch Biopsy Enough for a Severe Dysplastic Mole?

asked 5 months ago by CS28 in Plano, TX
Latest answer by Miriam Hanson, MD
Question viewed 374 times
Tags: abnormal, biopsy, punch excision, shave, worried

I had a mole shave biopsied and the result stated severely abnormal - recommend removing slightly more. Dermatologist said I needed to set up a punch biopsy. I went in and had this done and I think he removed it with 3mm margins. Im extremely concerned because after researching I have learned that severely atypical moles should be treated like melanoma in situ and be excised with 5 mm margins. Im concerned that it was not an excision and just a punch biospy as well. Should I be worried?

Also, others were removed through a shave biopsy - two were moderately atypical and one was mildly atypical. The dermatologist said that no further treatment was needed on any of these unless the area repigments. Is it possible that a shave biopsy can give clear margins on moderate atypical moles?

6 answers to Is a Punch Biopsy Enough for a Severe Dysplastic Mole?

Surgical margins should be clear for a severely dysplastic nevus

Dysplastic nevi are atypical "funny looking" moles that are often categorized as having mild, moderate or severe atypia. They are generally larger and darker than other moles and have irregular or indistinct borders. When an abnormal mole is identified, a shave or punch biopsy is often performed for diagnosis. If the dysplastic nevus is classifed as severe, I often recommend a 5mm clear margin. In my experience, it is often difficult to clinically and pathologically distinguish... more

Miriam Hanson, MD
Austin Dermatologist

A mole with severe dysplasia

The lesion needs to be excised such that there are microsopically clear margins. Punch biopsy or elliptical excision are both acceptable methods of excision as long as the margins are clear.

Philip Solomon, MD
Toronto Facial Plastic Surgeon

Removal with Clinically and Microscopically Clear Margins Important

Atypical Nevi (moles) that are severely or moderately atypical need to be completely excised both clinically and microscopically. Midly atypical nevi (sometimes called a Clark's Nevus) are considered, by most dermatologist, to be a variant of normal, and complete re-excision is not necessary. A Biopsy Punch is really a tool that is generally used to obtain a diagnosis (biopsy) but this tool may also be used for treatment (excision). Some Biopsy punches are large enough to... more

Jeffrey C. Poole, MD
Metairie Dermatologic Surgeon

A severely dysplastic mole is very close to melanoma.

A punch biopsy is enough only if it is VERY small. A severely dysplastic mole is very close to melanoma. I usually take at least a few millimeters margin to ensure the surrounding tissue is clear. The pathology report should show how close the lesion was to the margin. If it was close, I would recommend re-excision.

Missy Clifton, MD
Bentonville Dermatologist

Margins for atypical moles

I think it is important to get clinically clear margins (both visually and microscopically) when removing a biopsy-proven atypical mole. It's best not to get hung up over measurements in millimeters as these are only guidelines. In my office, we will do an excision with suture closure to get clear margins for all moles that have moderate to severe atypia. For a mildly atypical mole we will observe the area and, if any pigmentation recurs in the biopsy site in the future, a very small... more

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon

dorsetstreetdermatology.com

Moles and margin sizes

I don't think you need to be too concerned. Where were these moles would be my first question? Second, margins are used as guidelines. If the mole was tiny, a 3mm margin could have been just fine and a 5mm margin could have been excessive. Usually we take larger margins on places like the body (trunk, arms, legs) where the skin is a bit more forgiving and we take as minimal as possible on the face and hands, where there isn't a lot of skin to give. I don't even do punch biopsies... more

F. Victor Rueckl, MD
Las Vegas Dermatologist

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