Melanoma: Biopsy recommendations

  • Preferred biopsy technique is narrow excisional biopsy that encompasses entire breadth of lesion with clinically negative margins to depth sufficient to ensure that lesion is not transected, which may be accomplished by elliptical or punch excision with sutures, or shave removal to depth below anticipated plane of lesion.
  • Partial sampling (incisional biopsy) is acceptable in select clinical circumstances such as facial or acral location, low clinical suspicion or uncertainty of diagnosis, or very large lesion.
  • Repeat biopsy is recommended if initial biopsy specimen is inadequate for diagnosis or microstaging of primary lesion.

Strength of Recommendations: B Level of Evidence: II


Read more about the melanoma recommendations

The first step for a definitive diagnosis of cancer is a biopsy that may occur by removing part of the lesion (incisional biopsy) or the entire lesion (excisional biopsy). For a lesion clinically suspicious for cutaneous melanoma, one should ideally perform a narrow excisional biopsy that encompasses the entire breadth of the lesion with clinically negative margins to a depth sufficient to ensure that the lesion is not transected.8-18 It has been suggested that 1- to 3-mm margins are required to clear the subclinical component of most atypical melanocytic lesions.1,3,19 This can be accomplished in a number of ways including elliptical or punch excision with sutures, or shave removal to a depth below the anticipated plane of the lesion. The latter is commonly used when the suspicion of melanoma is low, the lesion lends itself to complete removal by this technique, or in the setting of a macular lesion suspicious for lentigo maligna where a broad biopsy specimen may aid in histologic assessment.11,16


View the AAD guidelines disclaimer.