Hand Mole Excision Sent off for Biopsy. Do I Need to Go Back? (photo)

2 weeks ago I had a mole on the lower middle palm of my right hand removed. It took off quite a big chunk of skin around and underneath. It was a little more than 1/16 of an inch deep. He said he was going to "go ahead and remove it all" that day and then send it off to be biopsied but now I'm told I have to go back in for a deeper cut that will require stitches because the results came back that the cells were "changing" they didn't said melanoma, they didn't say cancer, just changing.

Doctor Answers 6

All atypical moles do not need to be excised with sutures

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I fully disagree with the plastic surgeons below who state that you need a complete excision with sutures and even state that you need to see a plastic surgeon only! The shave biopsy/removal technique is the predominant procedure used by dermatologists to remove atypical moles. This technique produces a good cosmetic outcome and, if done well, produces an ideal specimen for histopathologic evaluation (which is also contrary to what is stated below). This technique is especially useful for volar nevi (moles on the palmar surface of the hand) such as yours. There are numerous references from other physicians who have reached the same conclusion. Here is one example of an article just published by a well respected dermatologist: Practical advice regarding problematic pigmented lesions; Dirk Elston, Journal of the American Academy of Dermatology, July 2012, Volume 67, Number 1, pages 148-155. In his article he specifically addresses volar nevi, saying "Saucerization with a narrow margin of normal-appearing skin produces an excellent diagnostic specimen with minimal functional impairment and good cosmetic outcome. This is my preferred technique." It would be wise to return to your physician to discuss the diagnosis so that you fully understand it as well as to discuss your treatment options.

South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Hand Mole Excision Sent off for Biopsy. Do I Need to Go Back?

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ARE you serious? Not going back? PLEASE have a complete excision, yes with sutures, and further pathology examination. As for copy of the biopsy report for your records and a further explanation. 

Yes, you need to go back for further removal

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Well, you can always call for specifics on exactly what the biopsy report came back as, but if I tell a patient to come back for further removal, then yes, it's necessary. Sometimes after I remove something, the report will actually come back that the margins aren't clear and therefore more needs to be removed. This is what I assume happened in your case - the area affected is just larger - and therefore more needs to be removed to be clear. If you want to find out what "changing" means, then I think you should call and ask, but yes, you need to return!

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Going Back For Review After Hand Skin Biopsy

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Absolutely, it is necessary for you to go back to your doctor so that you can get your biopsy results and learn what further treatment is recommended.

I expect that at your review appointment you will be told more than that the cells are "changing", that you will receive a full explanation of what the biopsy results show, and why further excision is recommended.

I strongly advise all patients to ensure that their tests results are followed up, which means making sure that you keep your post operative appointments. Doctors offices have protocols in place to try to ensure that every test is checked and followed up, but it is always safer if you check to make sure that your results were received and were normal. I have certainly heard of unfortunate cases where abnormal tests were not followed up or patients were unable to be contacted for further treatment of abnormal test results. Don't let this happen to you - when it comes to your health please play it safe!

Jill Tomlinson, MBBS, FRACS
Melbourne Plastic Surgeon

Yes, you need to communicate with your Dermatologist

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You need to find out exactly what the biopsy showed.  If it was an atypical nevus and there are residual cells remaining, it should be removed completely. Atypical nevi are somewhat challenging to manage because we really don't know the true malignant potential of such biopsies.  The slide is often rated with "mild," "moderate," or "severe" atypia.  Dermatologists will always recommend complete removal of nevi that have severe atypia, but the mild to moderate diagnosis we may recommend clinical observation if the margins are positive along the periphery of the specimen only and the nevus is predominantly superficially (compound, junctional nevus) and there is no residual pigmentation observable. It looks like a shave biopsy was performed in your case. 

The only other consideration that may result in a more aggressive approach is the location.  It is unusual to have nevi on the palms and soles, and I am particularly aggressive to biopsy these nevi.  Melanoma in these locations (acral lentigenous) are very aggressive and most Dermatologists will remove the nevi totally to be sure a melanoma does not develop.

Please follow up with your physician, I think all of us would recommend that. 

Curt Samlaska, MD
Las Vegas Dermatologist

Mole excision

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There is no argument, you have to have a full thickness excision. In that region Recommend a plastic surgeon, more familiar with the important structures underneath.

You deserve full explanation of the biobsy report and why a full thickness excision is required,

Moles in general should always be removed as full thickness for biobsy. That will allow the pathologist to examine the mole completely and in case of melanoma, then a complete description of the level of the melanoma is given.

Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.