Biopsy Any pigmented cutaneous lesion that has changed in size or shape or has other features suggestive of malignant melanoma is a candidate for biopsy. The recommended technique is an excisional biopsy, as that facilitates pathologic assessment of the lesion, permits accurate measurement of thickness if the lesion is melanoma, and constitutes treatment if the lesion is benign. For large lesions or lesions on anatomic sites where excisional biopsy may not be feasible (such as the face, hands, or feet), an incisional biopsy through the most nodular or darkest area of the lesion is acceptable; this should include the vertical. | Chapter 083. Cancer of the Skin Part 6 Biopsy Any pigmented cutaneous lesion that has changed in size or shape or has other features suggestive of malignant melanoma is a candidate for biopsy. The recommended technique is an excisional biopsy as that facilitates pathologic assessment of the lesion permits accurate measurement of thickness if the lesion is melanoma and constitutes treatment if the lesion is benign. For large lesions or lesions on anatomic sites where excisional biopsy may not be feasible such as the face hands or feet an incisional biopsy through the most nodular or darkest area of the lesion is acceptable this should include the vertical growth phase of the primary tumor if present. Incisional biopsy does not appear to facilitate the spread of melanoma. Staging Once the diagnosis of malignant melanoma has been confirmed the tumor must be staged to determine prognosis and treatment. The history should probe for evidence of metastatic disease such as malaise weight loss headaches visual difficulty or bone pain. The physical examination should be directed especially to the skin regional draining lymph nodes central nervous system liver and spleen. In the absence of signs or symptoms of metastasis few laboratory or radiologic tests are indicated for staging purposes. No tests or scans are routinely indicated unless the history or physical examination suggests metastasis to a specific organ. Once signs of metastasis exist favored sites of spread such as the liver lungs bone and brain should be evaluated. Patients are classified into four stages Table 83-3 . Melanoma Treatment Surgical Management For a newly diagnosed cutaneous melanoma wide surgical excision of the lesion with a margin of normal skin is necessary to remove all malignant cells and minimize possible local recurrence. The appropriate width of the margin is a source of controversy. A World Health Organization trial that prospectively randomized between 1- and 3-cm margins in 612 patients .
