Punch “scoring”: a technique that facilitates melanoma diagnosis of clinically suspicious pigmented lesions

Abstract

Aims

Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre-existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy "scoring" of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas.

Methods and results

Forty-one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy "score" (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in 9/41 cases (22%). In 8/9 cases (89%), the melanoma was associated with a naevus, and in 7/9 (88%) cases the melanoma was preferentially identified by the scored focus. In 6/9 cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ, the diagnostic material was only identified on further levelling through the scored focus. In 28/32 of non-melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathologic features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression.

Conclusions

The "punch scoring technique" allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focussing attention to clinically suspicious areas. Furthermore, it does not require special expertise in ex vivo clinical techniques for implementation. Nevertheless, examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma in some cases.

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