Need three more biopsies

This is why we use photographs to watch for change.  If the lesions are stable, there is no reason to biopsy.  Yes, you could have them removed if you want to, but melanoma shows up on new lesions about 50% of the time.  So removing existing moles is not the most effective.  90% of the melanoma population never have another melanoma primary – one is it.  You get to decide on what makes YOU feel comfortable.  Truthfully, I do the driving with my mel derm.  I've had 3 primaries and I expect to be the one to find any new ones.  My derm uses pics and I use my gut feel and own observation to determine if something has changed.  If a lesion is stable, though, I don't biopsy.  I don't have a ton of moles but the ones I do have we know would have atypical features if biopsied.   Bottom line is – do what makes YOU comfortable.  Not your derm, not anyone else.  This is your call.

Shave versus excision…. shaves have the problem that they might not go deep enough. Staging can be compromised if a melanoma lesion is bisected.  Full excisions are fine, but wide excisons have the possibility of removing too much tissue making a SNB, if needed later, suspect.  The SNB relies on lymph drainage paths showing the correct path to the sentinel node.  If you remove too much skin in the biopsy/excision, it is possible that the SNB could be compromised.  New drainage paths may be formed based on removing the tissue.  So it's a bit of a fine line with no absolute best choice.  I often chose a punch biopsy because it was a full skin thickness biopsy.  I wouldn't compromise on depth.  But punches have the problem of not being overly big.  8mm may be the largest and larger lesion may not be fully removed via a punch.  I personally do not allow shave biopsies – one for the reason I specified above, I might lose staging information if the shave was shallow and a melanoma deeper.  But #2 is that I think shave hurt more and heal worse than any other type of biopsy.  Your mileage may vary.

This is why we use photographs to watch for change.  If the lesions are stable, there is no reason to biopsy.  Yes, you could have them removed if you want to, but melanoma shows up on new lesions about 50% of the time.  So removing existing moles is not the most effective.  90% of the melanoma population never have another melanoma primary – one is it.  You get to decide on what makes YOU feel comfortable.  Truthfully, I do the driving with my mel derm.  I've had 3 primaries and I expect to be the one to find any new ones.  My derm uses pics and I use my gut feel and own observation to determine if something has changed.  If a lesion is stable, though, I don't biopsy.  I don't have a ton of moles but the ones I do have we know would have atypical features if biopsied.   Bottom line is – do what makes YOU comfortable.  Not your derm, not anyone else.  This is your call.

Shave versus excision…. shaves have the problem that they might not go deep enough. Staging can be compromised if a melanoma lesion is bisected.  Full excisions are fine, but wide excisons have the possibility of removing too much tissue making a SNB, if needed later, suspect.  The SNB relies on lymph drainage paths showing the correct path to the sentinel node.  If you remove too much skin in the biopsy/excision, it is possible that the SNB could be compromised.  New drainage paths may be formed based on removing the tissue.  So it's a bit of a fine line with no absolute best choice.  I often chose a punch biopsy because it was a full skin thickness biopsy.  I wouldn't compromise on depth.  But punches have the problem of not being overly big.  8mm may be the largest and larger lesion may not be fully removed via a punch.  I personally do not allow shave biopsies – one for the reason I specified above, I might lose staging information if the shave was shallow and a melanoma deeper.  But #2 is that I think shave hurt more and heal worse than any other type of biopsy.  Your mileage may vary.

This is why we use photographs to watch for change.  If the lesions are stable, there is no reason to biopsy.  Yes, you could have them removed if you want to, but melanoma shows up on new lesions about 50% of the time.  So removing existing moles is not the most effective.  90% of the melanoma population never have another melanoma primary – one is it.  You get to decide on what makes YOU feel comfortable.  Truthfully, I do the driving with my mel derm.  I've had 3 primaries and I expect to be the one to find any new ones.  My derm uses pics and I use my gut feel and own observation to determine if something has changed.  If a lesion is stable, though, I don't biopsy.  I don't have a ton of moles but the ones I do have we know would have atypical features if biopsied.   Bottom line is – do what makes YOU comfortable.  Not your derm, not anyone else.  This is your call.

Shave versus excision…. shaves have the problem that they might not go deep enough. Staging can be compromised if a melanoma lesion is bisected.  Full excisions are fine, but wide excisons have the possibility of removing too much tissue making a SNB, if needed later, suspect.  The SNB relies on lymph drainage paths showing the correct path to the sentinel node.  If you remove too much skin in the biopsy/excision, it is possible that the SNB could be compromised.  New drainage paths may be formed based on removing the tissue.  So it's a bit of a fine line with no absolute best choice.  I often chose a punch biopsy because it was a full skin thickness biopsy.  I wouldn't compromise on depth.  But punches have the problem of not being overly big.  8mm may be the largest and larger lesion may not be fully removed via a punch.  I personally do not allow shave biopsies – one for the reason I specified above, I might lose staging information if the shave was shallow and a melanoma deeper.  But #2 is that I think shave hurt more and heal worse than any other type of biopsy.  Your mileage may vary.