› Forums › General Melanoma Community › Shave biopsy or punch!
- This topic has 31 replies, 9 voices, and was last updated 7 years, 10 months ago by
Mokkes.
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- March 29, 2011 at 1:20 am
Please explain the difference. I know a shave is what it says & a punch is what it says but I get the impression that a shave biopsy isn't so great, why?
Please explain the difference. I know a shave is what it says & a punch is what it says but I get the impression that a shave biopsy isn't so great, why?
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- March 29, 2011 at 1:32 am
Have you had melanoma? Or is this a suspected melanoma? A shave should not be done on a suspected melanoma as they are "shaves" and are not as deep as a punch biopsy. On the off chance it is melanoma, the shave may transect (slice through) the melanoma tumor and a proper depth may not be able to be ascertained.
Actually, excisional biopsy is always the best route for a suspected melanoma.
Only problem is that derms prefer shaves as they are faster. Get you in, get you out!
Michael
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- March 29, 2011 at 1:32 am
Have you had melanoma? Or is this a suspected melanoma? A shave should not be done on a suspected melanoma as they are "shaves" and are not as deep as a punch biopsy. On the off chance it is melanoma, the shave may transect (slice through) the melanoma tumor and a proper depth may not be able to be ascertained.
Actually, excisional biopsy is always the best route for a suspected melanoma.
Only problem is that derms prefer shaves as they are faster. Get you in, get you out!
Michael
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- March 29, 2011 at 5:29 pm
shave biopsy biopsy of a skin lesion in which the sample is excised using a cut parallel to the surface of the surrounding skin.
Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens. It requires basic general surgical and suture-tying skills and is easy to learn. The technique involves the use of a circular blade that is rotated down through the epidermis and dermis, and into the subcutaneous fat, yielding a 3- to 4-mm cylindrical core of tissue sample.
If you suspect melanoma than you perfer not to have a shave biopsy but only because it makes getting the depth of the tumor impossible and therefor and accurate staging impossible. However, since the derm only takes a very small portion off the top, it is not the end of the world. Oncs don't like it. But there you go, two different worlds.
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- March 29, 2011 at 6:38 pm
I don't know terminology and a dermatologist didn't remove my mole, a PA at an Urgent Care did. She removed an elliptical .4mm and said the tissue underneath "looked good."
Long story short: path came back melanoma, surgical oncologist said a full 1mm needs to be removed, so he had to go back to site and remove more and at same time removed first 2 nodes…he did that dye tracking test to see where cancer cells would go if there were any between the time of initial path and this surgery. There was cancer in first so he went back, in second surgery, and removed remaining 25 nodes.
If you suspect melanoma, please have at least a full mm cut out and, if it comes back positive for melanoma, be prepared for futher tests to make sure it hasn't spread and stop it if it has. (I saw where someone said 3-4 mm and that sounds great, speaking as someone who has been there).
Scars are a small price to pay. Yes the procedures hurt like heck..but only for as long as they last and the needle stick time is relatively short. You'll live through the procedures. Don't opt for simpler or less-scarring procedures. Go in from the beginning with an attitude to win it. Melanoma is.
Here's hoping you'll be negative, but let's face it, you're suspicious for a reason. Still, praying for a good outcome.
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- March 29, 2011 at 6:38 pm
I don't know terminology and a dermatologist didn't remove my mole, a PA at an Urgent Care did. She removed an elliptical .4mm and said the tissue underneath "looked good."
Long story short: path came back melanoma, surgical oncologist said a full 1mm needs to be removed, so he had to go back to site and remove more and at same time removed first 2 nodes…he did that dye tracking test to see where cancer cells would go if there were any between the time of initial path and this surgery. There was cancer in first so he went back, in second surgery, and removed remaining 25 nodes.
If you suspect melanoma, please have at least a full mm cut out and, if it comes back positive for melanoma, be prepared for futher tests to make sure it hasn't spread and stop it if it has. (I saw where someone said 3-4 mm and that sounds great, speaking as someone who has been there).
Scars are a small price to pay. Yes the procedures hurt like heck..but only for as long as they last and the needle stick time is relatively short. You'll live through the procedures. Don't opt for simpler or less-scarring procedures. Go in from the beginning with an attitude to win it. Melanoma is.
Here's hoping you'll be negative, but let's face it, you're suspicious for a reason. Still, praying for a good outcome.
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- March 29, 2011 at 5:29 pm
shave biopsy biopsy of a skin lesion in which the sample is excised using a cut parallel to the surface of the surrounding skin.
Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens. It requires basic general surgical and suture-tying skills and is easy to learn. The technique involves the use of a circular blade that is rotated down through the epidermis and dermis, and into the subcutaneous fat, yielding a 3- to 4-mm cylindrical core of tissue sample.
If you suspect melanoma than you perfer not to have a shave biopsy but only because it makes getting the depth of the tumor impossible and therefor and accurate staging impossible. However, since the derm only takes a very small portion off the top, it is not the end of the world. Oncs don't like it. But there you go, two different worlds.
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- March 29, 2011 at 6:52 pm
You've gotten all the correct answers to this question but I'd like to add a couple of things. Sometimes the reasons for doing a shave biopsy have little to do with a derm's desire for speed, but rather with a desire to have less impact on the patient. For instance, on the face, a shave biopsy would be preferrable. But I don't believe a derm would suggest a shave biopsy on a suspected melanoma.
Almost every time we hear a story about a derm or other doctor doing a shave biopsy, it's been on something that they did NOT suspect was melanoma. Like the story below, the person doing the biopsy is saying..oh this looks fine, but we'll test it anyway. Sometimes, things look like melanoma and are not, and sometimes things don't look like melanoma and they are. Pathology is what tells it.
And, while a punch or excisional biopsy is much preferred to a shave biopsy, so that accurate Breslow's depth can be established, it's certainly not catastrophic to have a shave biopsy. MANY many people on this board have had shave biopsies by mistake. If your pathology comes back as melanoma, with either a punch biopsy or a shave, you still have melanoma. You still need to have further surgery, wide excision, maybe more.
good luck,
dian
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- March 29, 2011 at 6:52 pm
You've gotten all the correct answers to this question but I'd like to add a couple of things. Sometimes the reasons for doing a shave biopsy have little to do with a derm's desire for speed, but rather with a desire to have less impact on the patient. For instance, on the face, a shave biopsy would be preferrable. But I don't believe a derm would suggest a shave biopsy on a suspected melanoma.
Almost every time we hear a story about a derm or other doctor doing a shave biopsy, it's been on something that they did NOT suspect was melanoma. Like the story below, the person doing the biopsy is saying..oh this looks fine, but we'll test it anyway. Sometimes, things look like melanoma and are not, and sometimes things don't look like melanoma and they are. Pathology is what tells it.
And, while a punch or excisional biopsy is much preferred to a shave biopsy, so that accurate Breslow's depth can be established, it's certainly not catastrophic to have a shave biopsy. MANY many people on this board have had shave biopsies by mistake. If your pathology comes back as melanoma, with either a punch biopsy or a shave, you still have melanoma. You still need to have further surgery, wide excision, maybe more.
good luck,
dian
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- June 4, 2013 at 5:46 pm
I am very upset because my dermatologist only did a shave biopsy of a suspected leg mole that looked like melanoma – and turned out to be melanoma. I had asked him to fully remove it – going deep enough to get the roots – but he didn't. Won't be going back to that jerk!!
Anyway, the melanoma specialist he referred me to couldn't get me in for five weeks to do the Mohs – so in the meantime (four weeks after the shave) I've had some swelling in the area of the shave biopsy and can only wonder – is it metastasizing now because the careless dermatologist may have cut into the melanoma instead of fully removing it??
I know, from Internet research, that most dermatologists today are doing shaves for suspected melanoma instead of the punch biopsies they should be doing to be safe and fair to the patient. But the fact that most are doing shaves, doesn't make that OK or even the best choice.
I won't be having my Moh's until next week. Can anyone offer me some reassurance about this fiasco? I am really stressed about it and feel that all this could have been avoided is only my dermatologist had done what I asked!!
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- June 4, 2013 at 5:46 pm
I am very upset because my dermatologist only did a shave biopsy of a suspected leg mole that looked like melanoma – and turned out to be melanoma. I had asked him to fully remove it – going deep enough to get the roots – but he didn't. Won't be going back to that jerk!!
Anyway, the melanoma specialist he referred me to couldn't get me in for five weeks to do the Mohs – so in the meantime (four weeks after the shave) I've had some swelling in the area of the shave biopsy and can only wonder – is it metastasizing now because the careless dermatologist may have cut into the melanoma instead of fully removing it??
I know, from Internet research, that most dermatologists today are doing shaves for suspected melanoma instead of the punch biopsies they should be doing to be safe and fair to the patient. But the fact that most are doing shaves, doesn't make that OK or even the best choice.
I won't be having my Moh's until next week. Can anyone offer me some reassurance about this fiasco? I am really stressed about it and feel that all this could have been avoided is only my dermatologist had done what I asked!!
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- June 4, 2013 at 5:46 pm
I am very upset because my dermatologist only did a shave biopsy of a suspected leg mole that looked like melanoma – and turned out to be melanoma. I had asked him to fully remove it – going deep enough to get the roots – but he didn't. Won't be going back to that jerk!!
Anyway, the melanoma specialist he referred me to couldn't get me in for five weeks to do the Mohs – so in the meantime (four weeks after the shave) I've had some swelling in the area of the shave biopsy and can only wonder – is it metastasizing now because the careless dermatologist may have cut into the melanoma instead of fully removing it??
I know, from Internet research, that most dermatologists today are doing shaves for suspected melanoma instead of the punch biopsies they should be doing to be safe and fair to the patient. But the fact that most are doing shaves, doesn't make that OK or even the best choice.
I won't be having my Moh's until next week. Can anyone offer me some reassurance about this fiasco? I am really stressed about it and feel that all this could have been avoided is only my dermatologist had done what I asked!!
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- June 4, 2013 at 8:55 pm
Forgive me if I'm wrong, but I didn't think that Mohs procedures were indicated with melanoma. Shouldn't the OP be having a WLE (wide local exicision)?
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- June 4, 2013 at 9:46 pm
Thanks, Casagrayson, for your response. As my user name indicates, I'm new at this melanoma stuff. Only today learned about a "shave" versus a "punch" biopsy. Thanks for mentioning a WLE (wide local excision) – that may be what I am planned for next week at the cancer center, but I thought my dermatologist said "Moh's". Of course, I won't be returning to that guy!!
Would you please tell me something about what to expect with a WLE. It is really a big, deep area removed? Is it something I should take a Tylenol Extra Strength for before having? Also, if I'm wrong and if they plan a Moh's instead of a WLE, should I just refuse it? Please explain why Moh's aren't used with melanoma. Is a WLE a larger area than a Moh's?
Please share your experience or your loved one's experience regarding a WLE. Thanks. I'm starved for info!
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- June 4, 2013 at 9:46 pm
Thanks, Casagrayson, for your response. As my user name indicates, I'm new at this melanoma stuff. Only today learned about a "shave" versus a "punch" biopsy. Thanks for mentioning a WLE (wide local excision) – that may be what I am planned for next week at the cancer center, but I thought my dermatologist said "Moh's". Of course, I won't be returning to that guy!!
Would you please tell me something about what to expect with a WLE. It is really a big, deep area removed? Is it something I should take a Tylenol Extra Strength for before having? Also, if I'm wrong and if they plan a Moh's instead of a WLE, should I just refuse it? Please explain why Moh's aren't used with melanoma. Is a WLE a larger area than a Moh's?
Please share your experience or your loved one's experience regarding a WLE. Thanks. I'm starved for info!
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- June 4, 2013 at 9:46 pm
Thanks, Casagrayson, for your response. As my user name indicates, I'm new at this melanoma stuff. Only today learned about a "shave" versus a "punch" biopsy. Thanks for mentioning a WLE (wide local excision) – that may be what I am planned for next week at the cancer center, but I thought my dermatologist said "Moh's". Of course, I won't be returning to that guy!!
Would you please tell me something about what to expect with a WLE. It is really a big, deep area removed? Is it something I should take a Tylenol Extra Strength for before having? Also, if I'm wrong and if they plan a Moh's instead of a WLE, should I just refuse it? Please explain why Moh's aren't used with melanoma. Is a WLE a larger area than a Moh's?
Please share your experience or your loved one's experience regarding a WLE. Thanks. I'm starved for info!
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- June 4, 2013 at 9:50 pm
For: casagrayson
Also, I forgot to tell you that I couldn't see what you sent above your statement "Forgive me if I'm wrong . . ." I couldn't see it because it said "a plugin is needed to display this content" and I didn't have the right plugin to do it. Could you please re-send that missing information in a way that I wouldn't need a plug-in to read it. Thanks!
FirstMelanoma
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- June 4, 2013 at 9:50 pm
For: casagrayson
Also, I forgot to tell you that I couldn't see what you sent above your statement "Forgive me if I'm wrong . . ." I couldn't see it because it said "a plugin is needed to display this content" and I didn't have the right plugin to do it. Could you please re-send that missing information in a way that I wouldn't need a plug-in to read it. Thanks!
FirstMelanoma
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- June 5, 2013 at 4:01 pm
I didn't put anything in that area … it just shows up as a blank space for me. Very odd.
I'm truly no expert, so I'm hoping someone else with more experience chimes in. My husband has had multiple MOHS procedures on basal cell carcinomas. This is where the doctor takes a slice of tissue and studies it under the microscope to see if there are clear margins all around. If not, he goes back in a takes another thin slice. This procedure repeats itself until all the cancer cells are gone.
It used to be that MOHS was not the treatment of choice for melanoma. I found this in a previous post:
"Frozen section technique is not the best technique for determining melanoma. Melanocytes don't show up well under frozen sections. Slides done in paraffin and specific stains for melanocytes are a much more accurate technique. This is why Mohs is not typically done for melanoma. It was designed for Basal Cell and Squamous Cell carcinoma both of which show up well with frozen sections."
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- June 5, 2013 at 4:01 pm
I didn't put anything in that area … it just shows up as a blank space for me. Very odd.
I'm truly no expert, so I'm hoping someone else with more experience chimes in. My husband has had multiple MOHS procedures on basal cell carcinomas. This is where the doctor takes a slice of tissue and studies it under the microscope to see if there are clear margins all around. If not, he goes back in a takes another thin slice. This procedure repeats itself until all the cancer cells are gone.
It used to be that MOHS was not the treatment of choice for melanoma. I found this in a previous post:
"Frozen section technique is not the best technique for determining melanoma. Melanocytes don't show up well under frozen sections. Slides done in paraffin and specific stains for melanocytes are a much more accurate technique. This is why Mohs is not typically done for melanoma. It was designed for Basal Cell and Squamous Cell carcinoma both of which show up well with frozen sections."
-
- June 5, 2013 at 4:01 pm
I didn't put anything in that area … it just shows up as a blank space for me. Very odd.
I'm truly no expert, so I'm hoping someone else with more experience chimes in. My husband has had multiple MOHS procedures on basal cell carcinomas. This is where the doctor takes a slice of tissue and studies it under the microscope to see if there are clear margins all around. If not, he goes back in a takes another thin slice. This procedure repeats itself until all the cancer cells are gone.
It used to be that MOHS was not the treatment of choice for melanoma. I found this in a previous post:
"Frozen section technique is not the best technique for determining melanoma. Melanocytes don't show up well under frozen sections. Slides done in paraffin and specific stains for melanocytes are a much more accurate technique. This is why Mohs is not typically done for melanoma. It was designed for Basal Cell and Squamous Cell carcinoma both of which show up well with frozen sections."
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- June 4, 2013 at 9:50 pm
For: casagrayson
Also, I forgot to tell you that I couldn't see what you sent above your statement "Forgive me if I'm wrong . . ." I couldn't see it because it said "a plugin is needed to display this content" and I didn't have the right plugin to do it. Could you please re-send that missing information in a way that I wouldn't need a plug-in to read it. Thanks!
FirstMelanoma
-
- June 4, 2013 at 8:55 pm
Forgive me if I'm wrong, but I didn't think that Mohs procedures were indicated with melanoma. Shouldn't the OP be having a WLE (wide local exicision)?
-
- June 4, 2013 at 8:55 pm
Forgive me if I'm wrong, but I didn't think that Mohs procedures were indicated with melanoma. Shouldn't the OP be having a WLE (wide local exicision)?
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- June 6, 2013 at 4:00 am
I thought that Mohs surgery was done primarily for cosmetic reasons– by removing thin slices and checking them immediately under the microscope, the surgeon can remove the least amount of tissue as possible. I have heard of it being used most often on the face and eyelids, for example. However, it is not as accurate as a punch or a scallop biopsy for determining the type of cells or the depth of the lesion. That is probably why it is used when the doctor suspects basal cell or squamous cell carcinoma (which are slow growing and not very metastatic) but not when the doctor suspects melanoma.
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- June 6, 2013 at 4:00 am
I thought that Mohs surgery was done primarily for cosmetic reasons– by removing thin slices and checking them immediately under the microscope, the surgeon can remove the least amount of tissue as possible. I have heard of it being used most often on the face and eyelids, for example. However, it is not as accurate as a punch or a scallop biopsy for determining the type of cells or the depth of the lesion. That is probably why it is used when the doctor suspects basal cell or squamous cell carcinoma (which are slow growing and not very metastatic) but not when the doctor suspects melanoma.
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- June 6, 2013 at 4:00 am
I thought that Mohs surgery was done primarily for cosmetic reasons– by removing thin slices and checking them immediately under the microscope, the surgeon can remove the least amount of tissue as possible. I have heard of it being used most often on the face and eyelids, for example. However, it is not as accurate as a punch or a scallop biopsy for determining the type of cells or the depth of the lesion. That is probably why it is used when the doctor suspects basal cell or squamous cell carcinoma (which are slow growing and not very metastatic) but not when the doctor suspects melanoma.
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