Punch Biopsy or Shave Biopsy for a Suspicious Mole?

Question

I have medium skin tone with lot's of freckles and moles. I have had several moles removed via shave biopsy in the past. A new derm with great credentials removed two suspicious moles via the punch method. It was horrible!! She wants to remove 4 more. I asked why it can't be done by shave biopsy, then the more invasive punch if it's atypical. She doesn't like the biopsy to come back showing another removal is needed. She also said punch scars less. I'm so confused why different methods for Derms.

Raffy Karamanoukian, MD, FACS · Answer

Punch biopsy are standard in dermatology and mole biopsies.  You obviously have a choice of technique given your skin type and concern for scars.  I would discuss your preference with your doctor and opt for shave biopsy if you feel that you scar well with the technique. 

	 

	Both techniques can be used for pathologic examination.

Sam Naficy, MD, FACS · Answer

Depending on the appearance of the lesion, either a punch biopsy or a shave biopsy may be recommended.  If the lesion is suspicious for a melanoma, then I would completely excise the lesion.

Dev Wali, MD · Answer

In general a punch biopsy will give a more complete picture of the process than a shave biopsy. If the concern is a pigmented lesion that may be suspicious for skin cancer than I prefer complete excision when possible. A punch biopsy is a good alternative. Complete excision usually gives better scarring. I have a number of these on my website.

Andrew Kaufman, MD · Answer

If the pigmented lesion is truly suspicious for melanoma, complete excision should be performed. If the pigmented lesion is too large or in a cosmetically sensitive area, an incisional biopsy can be performed. In that instance usually a punch of the darkest or most raised portion of the pigmented lesion is removed, leaving the rest of the pigmented lesion intact.

	If a pigmented lesion is less suspicious for a melanoma, a shave removal can be performed. Shave removal may not remove all of the pigment cells so some lesions can recur, sometimes with varied colors. However, shave removal frequently works well for skin-colored lesions on the face.

	If you are not happy with the results from the current doctor, perhaps you should consider seeking a second opinion or having somebody else perform the surgeries. There are also other procedures available now that help to determine if a biopsy is truly necessary for a pigmented lesion and may also help to detect melanoma at an early point. This would include dermoscopy or digital dermoscopy (e.g. Molemax) and other technology (e.g MelaFind). You might talk to your doctor about some of these options. Good luck.

Samir Shureih, MD · Answer

Moles should be removed in total and submited for pathology.

	Shave biobsy does not show the deeper portion of the mole to do a complete examination of the invasion of the melanocytes down the layers of the skin.

	If malignant shave biobsy will not gove you a clear picture of the depth of invasion, and one loses that golden opportunity.

Mitchell Schwartz, MD - Account Suspended · Answer

As you can see from the answers thus far, everyone has their own opinion as to the best and safest method of biopsying a mole and they do what they do best and feel what is right for the patient. Unfortunately, plastic surgeons rarely do shave biopsies and are therefore biased against this procedure despite the medical literature showing how safe, effective, and easy it is to biopsy a mole with minimal scarring using a shave technique. Several of the statements made so far about shave biopsies are actually incorrect when compared with what has been proven in the medical literature. I recommend you find a new dermatologist that does both shave and punch biopsies so they can recommend when each method would be appropriate.

	You can follow the video link below to learn more about identifying the changes in moles that are suspicious for skin cancer.

Punch Biopsy or Shave Biopsy for a Suspicious Mole?

Answers (6)

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