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Survey Highlights Different Biopsy Techniques Between Dermatologists and Plastic Surgeons

A recent survey addressed the different approaches in treating Spitz nevi (SNs) and atypical Spitz tumors (ASTs) between dermatologists and plastic surgeons. 230 physicians participated, comprised of 136 dermatologists and 94 plastic surgeons. 

In the first scenario, physicians were asked how they would treat a 7 year old with a clinically suspected SN.  21% of dermatologists chose to observe the lesion, 45% chose full-thickness removal, and 22% chose shave biopsy. Only 2% of plastic surgeons chose to observe the lesion, 96% chose full-thickness removal, and none chose shave biopsy. The results drastically changed when the patient’s age was adjusted to 18 years old. Only 4% of dermatologists and 1% of plastic surgeons chose observation. Other scenarios addressed recurrence after biopsy, biopsy resulting in an AST with clear margins, and a child with an AST with a positive margin.

Variations within approaches exposed that dermatologists take age into consideration, and are more likely to prefer shave biopsy to punch biopsy. While there are few published guidelines on managing Spitz nevi, this survey brought to light that many dermatologists are treating it from different perspectives. 

The study concluded that these differences are important to acknowledge, so that they can either be validated and mainstreamed, or deemed as unsuitable practices.  As Physician Assistants, it will be important to stay up to date on recommendations pertaining to which biopsy to use. 

Source: 1

Image: Tudor Barker

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