Baffling reaction to a suspicious lesion

LEARNING POINTS

• Deep-shave biopsy (sometimes called saucerization) is an appropriate technique for possible melanoma.

• About 75% to 80% of all melanomas are superficial, spreading types, (essentially flat), while 10% or so have only a vertical phase of growth (ie, present as a nodule or mass).

• Survival rates for melanoma are closely tied to tumor thickness, which is most commonly measured (by the pathologist) in millimeters; this staging system is called the Breslow scale. The older system of staging melanoma by the anatomical depth (called the Clark’s level I-V) has fallen into disuse.

• Underreaction to the diagnosis of melanoma (la belle indifference) can be as problematic as overreaction. Consistent monitoring of patients for compliance is often necessary.