Figure 1-This figure is taken from the article cited in the title. It neatly and correctly demonstrates how a pigmented lesion may be grossly present at the punch or shave margins but on histologic sections, the "margins" appear negative. Only an elliptical excision can adequately and correctly examine the margins.

Issues in Dermatopathology

When To Ask Your Dermatopathologist to Evaluate for Surgical Margins?

Sellhyer K. and Bergfeld WF. J Am Acad Dermatol 2005;52:1095-1097
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I am thankful for this timely article written by our colleagues at the Cleveland Clinic. It is an editorial comment discussing the results of an e-mail survey sent to members of the American Society of Dermatopathology (I was one of the participants).

The problem arises when dermatologists ask a dermatopathologist to comment on the margins for a melanocytic lesion (such as a dysplastic nevus) for a punch or shave biopsy. The authors emphatically state that the question should not be posed in the first place.

Dermatopatholgists (%) Commenting on Margins-Melanocytic Nevi

The reporting rate of margins is much higher for dysplastic nevi, with 67.8% reporting margins in severely dysplastic nevi. Note that almost half of the dermatopathologists do not report margins on excised nevi but 93.4% did report margins on excised melanoma.

This variation in margin reporting is equaled by the variation in terminology used to report the findings.

Terminology for positive margins included:

At biopsy specimen
Transected
Biopsy edges involved

Terminology for negative margins included:

Appears completely excised
On limited margin evaluation the edges are clear
Observed margins are uninvolved
Demonstrated margins are not involved
Borders clear
On limited margin evaluation the edges appear free
Margins free in examined sections

The authors' summary statement is reproduced here:

In our opinion, negative margins should only be reported in elliptical excisions and not in lesions that are shaved or punched. In punch or shave biopsies, only positive margins can be called reliably.

The diagram from the paper, which is reproduced in Figure 1, clearly demonstrates the fallacy of a "negative margin" in a punch or shave biopsy.

Through the years, I have been asked to comment on margins in punch and shave biopsies for melanocytic nevi as well as for basal cell and squamous cell carcinomas. I have had numerous discussions with dermatologists over my misgivings of reporting the margin status on a punch or shave biopsy. Unfortunately, I still do report the margin status, thus contributing to the very situation the authors bemoan. I hope this article brings awareness and understanding to a sorely neglected topic.

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Additional References:

Evaluation of surgical margins in melanocytic lesions: a survey among 152 dermatopathologists. Sellheyer K, Bergfeld WF, Stewart E, Roberson G, Hammel J. J Cutan Pathol. 2005 Apr;32(4):293-9.

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