An excisional biopsy with a 1- to 3-mm border around the lesion
“The AAD recommends doing an excision with narrow margins (1–3 mm) that includes the entire gross lesion with clinically negative margins to a depth that ensures the lesion is not transected. For smaller lesions punch excision with sutures or shave removal to an adequate depth are acceptable alternatives if the recommended excision objectives can be met. Once the tissue diagnosis is obtained, appropriate staging and definitive surgery should be undertaken.” ABFM critique.
**The goal is to remove the entire Melanoma, get all the way under it and all around it with good margins to get the entire thing out. For small melanomas, if punch or shave can get the whole thing out, they are acceptable approaches.
Further Reading
J Am Acad Dermatol 2011;65(5):1032-1047. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology.