Would you biopsy this dark lesion?

During a skin examination, a lesion is noted on the thigh of a 32-year-old woman. The patient says she has had the “spot” all of her life, and its appearance has not changed.

What is your next step?

A. Measure the lesion and reexamine the patient in 6 to 12 months.

B. Perform a shave biopsy immediately.

C. Perform a punch biopsy immediately.

D. Schedule the patient for an excisional biopsy within the next few weeks.

E. Treat the lesion with cryosurgery.

Answer: Melanoma

The lesion had an irregular notched border and variegated coloration typical of a melanoma. An excisional biopsy, D, confirmed the diagnosis. The Breslow depth of invasion was 0.43 mm; there was no evidence of regional lymph node involvement. Reexcision with narrow (1-cm) margins was performed. Two years after surgery, the patient is doing well without any sign of recurrence.