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What do they mean by all these different wide, clear, narrow margins.. when do you do each? For example, basal cell carcinoma has mohs micrographic excision.. but when would you do a wide 1cm excision, melanoma? Squamous cell carcinoma? When do you do wide excision, when do you clear margin excision, and how do you decide how many cm it will be? What does clear margin excision mean? What does wide margin, narrow margin excision, punch biopsy, etc mean and when to use?
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still seeking help on this..
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The suspicious lesion should be excised completely with a 2 to 3 mm surgical margin. according to textbook
But in the clinic I excise upto 5mm of normal skin
The diagnosis of melanoma should be confirmed by histological examination of the entire specimen.
Incisional biopsies are not recommended as they may miss a malignant focus within a benign lesion, and because early melanoma can be subtle histologically.
Re-excision margins depend on the site of the lesion and its Breslow depth. There should be a clearance width and depth of 1 cm for all invasive tumours and deep to fascia.
Tissue-sparing Mohs micrographic surgery may be worthwhile for lentigo maligna melanoma, in which clinical margins are frequently unclear.
About 25% of melanomas 1.5-4mm thick have microscopic lymph node involvement at the time of primary diagnosis, and 60% if >4mm thick. Elective lymph node dissection is not recommended because of significant morbidity and may not improve survival. However, in cases without palpable regional lymphadenopathy, lymphatic mapping and sentinel node biopsy should be considered (if available locally) for melanomas >1 to 1.5 mm in thickness
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@drchithu
So for suspected melanoma looking lesion you would do excisional biopsy?
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yes for suspected melanoma - do completly excise the lession with 3mm margin and send it for histopathology.then based on biopsy plan for wide excission by reffering pt to plastic surgeon.
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Nice answer. But what do clear, narrow, wide, and punch biopsy mean? Can someone clarify the difference between these?
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okay
1.if you have a mole or wart etc if its benign looking but not 100 % sure ,you need a histological input you do a narrow margin.
2.if you have a lession thats looking slightly more suspicious but going more in favour of bening lession you would do a clear margin eg-bcc
3.if a lession has strong suspicion of malignancy you would do a wide excission.1st and depending on breslows thickness you go and do a wider excission later on .
4.punch biopsy,using a pen like instrument its got a circular blade at the tip(either 3mm/6mm diameter) you press down on the area (that you want to biopsy) (ofcourse after Local anesthetic infilteration )you get a chunk of tissue, you would do this mostly for inflamatory/autoimmune lessions eg psoriasis phemphigus,lichen, etc very rareley for malignant lessions (for eg a large scc in the border of marjolins ulcer or chronic scar (you are suspecting malignant change)
hope this makes sense...
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