The inadequacy of punch-excised melanocytic lesions: Sampling through the block for the determination of “margins”

AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: A report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery

“…It should also be understood that the initial biopsy specimen of a cutaneous malignancy that prompts categorization of appropriate use of MMS may misrepresent the true histopathological findings of final tumor characteristics, particularly if the initial biopsy specimen is superficial or partial. [206][207][208][209][210][211][212] Thus it is important when using the AUC documented herein that an appropriate and accurate biopsy of the represented cutaneous malignancy has been performed, as these clinical scenarios pertain to welldefined pathologic diagnoses.…”

“…187 5. Available data demonstrate that the initial partial biopsy specimen may misrepresent histopathological findings of final tumor characteristics [206][207][208][209][210][211][212] ; the later findings may supersede those of the initial biopsy specimen as the indication for consideration of MMS. In addition, if for any reason, based on tumor type/subtype, size, or location, the lesion can be assigned to more than 1 indication (eg, coexistence of 2 subtypes of BCC within the same lesion), it should be classified according to the most aggressive feature.…”

Margin Status in Shave Biopsies of Nonmelanoma Skin Cancers: Is It Worth Reporting?

“…In a similarly designed study by Chang et al, 8 greater than one-third of all punch excisions of melanocytic nevi with apparently negative margins on initial examination were found to have positive margin involvement upon through-block sectioning. Conservative elliptical excisions, which have slightly wider margins than shave biopsies but narrower margins than formal excisions, are also vulnerable to margin assessment error.…”

“…Some clinicians establish further treatment decisions based on whether the neoplasm was eradicated via biopsy. 9 As Chang et al 8 reason, reporting margins in skin biopsy specimens provides clinicians with the misconception that margins can be accurately assessed by routine histologic examination. Moreover, as diagnostic reports become increasingly available to patients, one must also consider patient interpretations of their biopsy reports and their potential refusal for subsequent intervention upon receiving a report with language suggesting that their neoplasm has been ''eradicated'' by biopsy alone.…”

“…Extraneous sectioning of specimens results in a delay in turnaround times, is costly, and is accompanied by a higher work burden for both histotechnologists and pathologists involved in the case, particularly when deeper levels are ordered retrospectively. 8,13 Instead, we suggest that the decision about whether to provide a margin status in a biopsy of NMSC be made on a case-by-case basis, balancing any known intent of the biopsy and postbiopsy treatment procedures with the potential risk for misunderstanding by the clinician and/or patient population for each institution. Because of this study, in agreement with our dermatology department, we revised our reporting practices for NMSCs.…”