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A shave biopsy? What was my dr thinking?

Forums General Melanoma Community A shave biopsy? What was my dr thinking?

  • Post
    Mapes84
    Participant

    Hello all! I was hoping to gain some insight as to why my derm may have decided to perform a shave biopsy on my last appointment. Her decision to do this is causing me some anxiety!

    A little history: I was diagnosed with a melanoma in situ in 2009 at the age of 25. I had a WLE (no SLNB), and haven't had any problems since. I have been attending my check ups twice yearly, and I have had two other spots biopsied since the melanoma. My derm performed punch biopsies for both of these. One of them came back atypical, but they were both benign.

    Hello all! I was hoping to gain some insight as to why my derm may have decided to perform a shave biopsy on my last appointment. Her decision to do this is causing me some anxiety!

    A little history: I was diagnosed with a melanoma in situ in 2009 at the age of 25. I had a WLE (no SLNB), and haven't had any problems since. I have been attending my check ups twice yearly, and I have had two other spots biopsied since the melanoma. My derm performed punch biopsies for both of these. One of them came back atypical, but they were both benign.

    I had a check up on Thursday, and I showed my dr. a spot that has had me particularly concerned. I noticed one day that it had a strange appearance (irregular border, two shades of brown) and made a mental note to "watch it", as I had a check up approaching within the month. Almost overnight, the spot (which had been completely flat) started to feel elevated. A few days later, it started scabbing. Eek.

    Anyway, predictably, she said she would do a biopsy "to be on the safe side". As usual, I turned and looked the other direction while she performed the biopsy because that stuff turns my stomach :p . Suddenly, I felt her putting a bandage on, and I realized that it was over way too quickly. I asked her if she had performed a shave biopsy this time, and she stated that she had. I asked her (politely) why, since we have never done this before. She stated, "I have my reasons" (?!), then mumbled something about catching it really early if it was anything bad.

    I don't claim to be a doctor, and I don't know a ton about this stuff, but I was under the impression that shave biopsies are a big no-no if melanoma is even remotely suspected. Was this done out of laziness? I don't understand. Is it time to look for a new dr.?

    I am still awaiting biopsy results, but my next question is this: I am aware that a shave biopsy can interfere with staging if melanoma is present. Can a shave biopsy result in a false-negative? This is really bugging me.

    Thank you in advance!

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  • Replies
      washoegal
      Participant

      A shave biopsy won't result in a false negative.  The only thing it does is if she didn't get all of the mole, then then correct depth cannot be determined.  Sometimes with a shave they can get all of it, so at this point it a wait and see. 

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      washoegal
      Participant

      A shave biopsy won't result in a false negative.  The only thing it does is if she didn't get all of the mole, then then correct depth cannot be determined.  Sometimes with a shave they can get all of it, so at this point it a wait and see. 

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      Janner
      Participant

      Shave biopsies are only a problem IF it is melanoma, and IF the shave transects the lesion.  Then staging info may be lost.  Both are unlikely in your case.  (Multiple primaries only happen in about 8% of the melanoma population, and most lesions are actually slow growing).  Some derms will stand by deep shaves as the best biopsy type.  And in some size lesions or anatomical locations, shaves may indeed be the best option.  However, I do believe that most derms use shaves because they are quick and easy and require no stitches.  In your case, I'd just tell your derm to write on your chart that you request no shave biopsies unless you explicitely say it is ok.  I have ok'd shaves on lesions I was sure were not melanoma… a squamous cell for example.   I discuss the biopsy type, etc. with my doc before he does one.

      Don't stress too much, it's actually more important that the biopsy is done than the type of biopsy. 

      Best wishes,

      Janner

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      Janner
      Participant

      Shave biopsies are only a problem IF it is melanoma, and IF the shave transects the lesion.  Then staging info may be lost.  Both are unlikely in your case.  (Multiple primaries only happen in about 8% of the melanoma population, and most lesions are actually slow growing).  Some derms will stand by deep shaves as the best biopsy type.  And in some size lesions or anatomical locations, shaves may indeed be the best option.  However, I do believe that most derms use shaves because they are quick and easy and require no stitches.  In your case, I'd just tell your derm to write on your chart that you request no shave biopsies unless you explicitely say it is ok.  I have ok'd shaves on lesions I was sure were not melanoma… a squamous cell for example.   I discuss the biopsy type, etc. with my doc before he does one.

      Don't stress too much, it's actually more important that the biopsy is done than the type of biopsy. 

      Best wishes,

      Janner

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      Mapes84
      Participant

      Thank you both- this makes me feel better about things!

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      Mapes84
      Participant

      Thank you both- this makes me feel better about things!

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      vivian
      Participant

      I am not sure about this.  I had three biopsies on the same lesion within six weeks.  The first was a shave and showed "lichenoid keratosis".  The second, two weeks later, also a shave biopsy, was reported to be "atypical melanocytic proliferation".  The third biopsy, another two weeks later, was a complete excision and the results were "nodular malignant melanoma, Clark's level 5,  Breslow depth 4.35 mm, mitotic rate 9 per mm2".   It is very hard to believe that within 6 weeks, that lesion changed from nothing to stage III melanoma with spread to one lymph node.  I believe something was done wrong, either by the dermatologist or the lab.  Even though I have asked every doctor since, no one has said straight out that the shave biopsy can show a false negative, but neither have they said for sure that lichenoid keratosis can become melanoma of that depth in such a short time.   It is what it is now, but I will insist on at least a punch biopsy for anything from here on out.  

      I will be thinking about you and hoping your biopsy comes back totally fine!

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        shanrhobbs
        Participant

        My husband was told last week following a shave biopsy that he has a MM with Clark’s level 4 and Breslow is 3.3mm with mitotic rate of 20. The mole came up rapidly on his tragus and was sticking up quite a bit. We met with the ENT, oncologist yesterday and she said a shaved biopsy doesn’t show the depth of the  MM only how thick it was and she did a punch biopsy and we go back Monday. My husband and I are both 30 and have four kids. This has came as a complete shock and we are scared to death. 

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      vivian
      Participant

      I am not sure about this.  I had three biopsies on the same lesion within six weeks.  The first was a shave and showed "lichenoid keratosis".  The second, two weeks later, also a shave biopsy, was reported to be "atypical melanocytic proliferation".  The third biopsy, another two weeks later, was a complete excision and the results were "nodular malignant melanoma, Clark's level 5,  Breslow depth 4.35 mm, mitotic rate 9 per mm2".   It is very hard to believe that within 6 weeks, that lesion changed from nothing to stage III melanoma with spread to one lymph node.  I believe something was done wrong, either by the dermatologist or the lab.  Even though I have asked every doctor since, no one has said straight out that the shave biopsy can show a false negative, but neither have they said for sure that lichenoid keratosis can become melanoma of that depth in such a short time.   It is what it is now, but I will insist on at least a punch biopsy for anything from here on out.  

      I will be thinking about you and hoping your biopsy comes back totally fine!

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