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Punch ‘scoring’: a technique that facilitates melanoma diagnosis of clinically suspicious pigmented lesions
Author(s) -
Grogan Judith,
Cooper Caroline L,
Dodds Tristan J,
Guitera Pascale,
Menzies Scott W,
Scolyer Richard A
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13342
Subject(s) - melanoma , medicine , biopsy , lesion , pathological , breslow thickness , dermatology , atypia , pathology , radiology , cancer , breast cancer , sentinel lymph node , cancer research
Aims Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre‐existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy ‘scoring’ of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas. Methods and results Forty‐one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy ‘score’ (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in nine of 41 cases (22%). In eight of nine cases (89%) the melanoma was associated with a naevus, and in seven of nine (88%) cases the melanoma was identified preferentially by the scored focus. In six of nine cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ , the diagnostic material was identified only on further levelling through the scored focus. In 28 of 32 of non‐melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathological features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression. Conclusions The ‘punch scoring technique’ allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focusing attention on clinically suspicious areas. Furthermore, it does not require special expertise in ex‐vivo clinical techniques for implementation. Nevertheless, in some cases examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma.