title: The inadequacy of punch-excised melanocytic lesions: sampling through the block for the determination of "margins".
abstract: BACKGROUND
  Dermatopathologists often are asked by clinicians to report margins on punch excisions of melanocytic lesions.
  
  
  OBJECTIVE
  We sought to determine the adequacy of surgical margins on melanocytic lesions submitted with intention of complete excision using punch removal technique.
  
  
  METHODS
  We conducted prospective analysis of surgical margins on 266 consecutive patients who underwent attempted complete removal of 405 melanocytic nevi submitted as punch and fusiform excisions.
  
  
  RESULTS
  Of 206 nonbisected punch excisions, 127 (62%) had final positive margins. Of 159 bisected punch excisions, 76 (48%) had final positive margins. Of 40 elliptical excisions, two (5%) had final positive margins.
  
  
  CONCLUSIONS
  Information on the perilesional rim of nonpigmented skin included in the excision was not available.
  
  
  CONCLUSIONS
  Of punch excisions, 56% had positive margins. Importantly, 30% of these punch excised specimens were negative on initial levels but had positive margins after extensive sectioning, affirming that fusiform excisions are the preferred method to evaluate margins in melanocytic lesions.
authors.affiliation: Departments of Dermatology and Pathology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
authors.forename: Timothy T
authors.initials: TT
authors.lastname: Chang
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Somach
authors.forename: Kyle
authors.initials: K
authors.lastname: Wagamon
authors.forename: Ally-Khan
authors.initials: AK
authors.lastname: Somani
authors.forename: Jerome
authors.initials: J
authors.lastname: Pomeranz
authors.forename: Christine
authors.initials: C
authors.lastname: Jaworsky
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bass
authors.forename: Harry L
authors.initials: HL
authors.lastname: Winfield
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Sigel
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Rosenberg
mesh_terms: D006801:Humans; D009508:Nevus, Pigmented / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods