Is a Punch Biopsy Enough for a Severe Dysplastic Mole?

Question

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?

Matthew Richardson, MD · Answer

A punch biopsy can be used as a tool for obtaining clear margins around a lesion depending on the size of the lesion and the size of the punch biopsy instrument. A shave biopsy is generally not going to obtain any sort of clear margins. The difference between 3 mm and 5 mm margins is very small and is going to be difficult to determine after excision/biopsy. Following up with your dermatologist and checking the area regularly would probably be the recommended course of action, but be sure to follow your doctor's advice.
All the best,

Philip Solomon, MD, FRCS · Answer

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.

Miriam Hanson, MD · Answer

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 these lesions from melanoma in situ.

Missy Clifton, MD · Answer

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.

Jeffrey C. Poole, MD - Account Suspended · Answer

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 encircle the entire lesion along with the necessary margin for clearance.  If the lesion is completely removed with adequate microscopic margins, you should be fine.

	One thing to keep in mind-- the science of pigmented lesions is imperfect.  There is great debate within the scientific community about exactly what an atypical mole really means, about the necessity to treat and what the proper treatment is.   Be sure to consult with a respected, Board Certified Dermatologist that you trust and have a good rapport.  This is the best way to obtain your best care.

Is a Punch Biopsy Enough for a Severe Dysplastic Mole?

Answers (7)

Answer: A severely dysplastic mole is very close to melanoma.

Answer: A severely dysplastic mole is very close to melanoma.

Answer: Removal with Clinically and Microscopically Clear Margins Important

Answer: Removal with Clinically and Microscopically Clear Margins Important

Recommended reading

Everything you need to know about Mole Removal

Our mission is to create a world where every investment in modern beauty is Worth It.

Is a Punch Biopsy Enough for a Severe Dysplastic Mole?

Answers (7)

Answer: A severely dysplastic mole is very close to melanoma.

Answer: A severely dysplastic mole is very close to melanoma.

Answer: Removal with Clinically and Microscopically Clear Margins Important

Answer: Removal with Clinically and Microscopically Clear Margins Important

Browse related questions

Recommended reading

Everything you need to know about Mole Removal

Our mission is to create a world where every investment in modern beauty is Worth It.