Which melanocytic lesions should be excised?
Lesions with the typical clinical and/or dermoscopic characteristics of melanoma should be excised with a 2-mm margin and the specimen sent for pathology. To guide the pathologist to evaluate a small area that is of concern, orientate the specimen using edge incisions, sutures or ink, and draw a map on the request form. Alternatively, make a superficial round incision using a 1 to 2-mm micropunch in the area of interest and leave the punch in place. Atypical lesions that do not have diagnostic features for melanoma may also be excised for histology. Melanoma can arise from a naevus, but in about 70% of cases arises de novo. Initially de novo melanoma may lack diagnostic features of melanoma and may also lack features of naevi. • Single atypical lesions • Nodular atypical lesions • Changing atypical lesions Whole body photographs and digital dermoscopic monitoring may be preferred for: • Multiple mildly atypical lesions (12-month intervals) • Changing naevus without atypia (3- to 6-mont
