What Is the Most Appropriate Approach to This Lesion?

Author: 
David L. Kaplan, MD—Series Editor

Citation:
Kaplan DL. What is the most appropriate approach to this lesion? Consultant. 2018;58(8):214. 

This 56-year-old man presented for a routine annual skin examination and was noted to have this 4-mm pigmented lesion on his trunk.

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Answer: Do a 4-mm punch biopsy or deep-shave removal

The biopsy of this lesion revealed a pigmented basal cell carcinoma, which mimics melanocytic lesions that are atypical or malignant. This lesion can be removed by either a 4-mm punch biopsy or a deep shave removal for evaluation. A wide excision is not appropriate in the absence of histologic confirmation of the diagnosis. A 2-mm punch biopsy risks a sampling error and is not necessary on a small lesion such as this one. The clinical presentation in this patient’s case suggests the need for a biopsy rather than a wait-and-watch strategy. 

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.