In this video blog, Dr. Christine Cornejo focused on the highlights from her lecture "Melanoma Updates" when she presented on Saturday, November 11, 2023, at the 4th Annual Elevate-Derm Alliance PA/NP Conference at Coachella Valley, CA.

In this video

Dr. Cornejo explains that while the literature describes multiple acceptable ways to biopsy a suspicious lesion, the most important goal is capturing as much of the lesion as possible without transecting its depth — because knowing the final depth is what determines the melanoma's stage. She notes that once a lesion is transected, you can't simply add the measurements back together, and often "when we go back, there's nothing left" due to the immune response. Her preferred approach is a scoop shave using a 15 blade to score around the entire lesion, giving good control down to the mid-to-reticular dermis; she'd rather go a bit deeper than needed than end up too superficial. Punches are an option for smaller lesions but risk missing part of a broad or irregularly shaped lesion.

On the "hot topic" of prognostic gene expression profile (GEP) testing, Dr. Cornejo cautions against relying on it for now. Although these commercially available tests look for genes associated with worse prognosis in an already-diagnosed melanoma, they are not currently recommended by the AAD or NCCN for clinical use. Patients sometimes arrive with a result in hand asking about sentinel lymph node biopsy, imaging, or follow-up, but there's no data to guide those decisions yet. She sees promise for the future — "maybe part of our clinical practice" — but says "for now we're not ready for it."

  • When biopsying a suspected melanoma, capture as much of the lesion as possible without transecting its depth, so you can determine the final depth and stage.
  • A scoop shave with a 15 blade scored around the whole lesion gives good depth control to the mid-to-reticular dermis; err toward going deeper rather than too superficial.
  • Punch biopsies work for smaller lesions but may miss part of a broad or irregularly shaped lesion.
  • Prognostic GEP testing is generating buzz but is not recommended by the AAD or NCCN for clinical use, and there's no data on how to act on the results.
  • Even when referring to an academic center, prognostic GEP testing is not currently part of the clinical standard of care.