Biopsy Guidelines for Suspected Melanoma

Introduction to Biopsy Methods

The American Academy of Dermatology recommends narrow excisional/complete biopsy with 1-3 mm margins as the gold standard for suspected melanoma, as it provides accurate pathological staging and prevents transection at the base 1, 4, 5
Punch biopsy is generally not recommended for suspected melanoma and should only be used in highly select circumstances, such as facial lentigo maligna, acral melanoma, or very large lesions where complete excision is not feasible, due to its high upstaging rates and potential for inaccurate Breslow thickness measurements 1, 2, 3

The preferred approach is narrow excisional/complete biopsy with 1-3 mm margins, which can be accomplished through fusiform/elliptical excision, punch excision, or deep shave/saucerization to depth below the anticipated plane of the lesion 1, 4
The British Association of Dermatologists suggests that incisional or punch biopsy may be acceptable in specific circumstances, such as facial lentigo maligna, acral melanoma, or very large lesions, but should only be performed by specialists within a skin cancer multidisciplinary team 2, 3, 6

The National Comprehensive Cancer Network recommends that partial biopsies should only be performed by specialists within a skin cancer multidisciplinary team, not in primary care settings, to ensure accurate diagnosis and staging 2, 3, 6
The American Academy of Dermatology advises against performing superficial shave biopsies for suspected invasive melanoma, as they underestimate Breslow thickness and clinical stage 4

For a suspicious pigmented lesion, the algorithm recommends performing narrow excisional biopsy with 1-3 mm margins if feasible, considering incisional or punch biopsy only if performed by a specialist within a multidisciplinary team for facial, acral, or very large lesions, and proceeding to narrow margin excision for accurate microstaging if punch biopsy is inadequate 1, 2, 3, 4, 7