How do you convince a dermatologist

Posted By
4/19/2017 9:57pm
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Replies: 11

To only do punch biopsies?  My husband has had two primaries, both of which were biopsied with shave biopsies.  He's had dozens of biopsies since, and the derm *always* shaves.  I even asked last month, when they were removing a really ugly lesion (which turned out to be squamous) if he would do a punch, and the med assistant said that he wouldn't.  We have another appointment tomorrow for another bad spot on his skull, and I *really* want to move to punch biopsies.  Any suggestions for how to approach this?  (He's a really great doctor, very caring, but just very busy and I think shaving these things takes less time.)


Strength and Courage,


Any suspicious pigmented lesion should be removed via punch.  I would politely insist and if your wishes are not granted, find another dermatologist 

Agree with above comment. Your husband needs to be firm on wanting punch or excisional biopsies only. A good derm would take that request with no problem... a good derm with a good understanding of skin cancer wouldn't shave biopsy anyway... so, if his derm won't do it, he needs a new derm.

Jenn - stage IV NED - Completed Ipi/Nivo (Yervoy/Opdivo) + surgery

Anonymous - (4/20/2017 - 6:27am)

If your husband has had two melanomas, then it is absolutely out of the question to do punch OR shave biopsies in my opinion. I now will only accept full excisional biopsies - a cut and stitch thing - to ensure the full lesion is gone. This is in line with Australian guidelines - and we Aussies (and Kiwis) know melanoma back to front.

It's a tough situation-you are trying to convince your Dr that he is wrong. If there is one thing I know Drs don't like to be told they are wrong. I personally would find a new one. If he doesn't know the protocol with this-what else is he failing to do?

He is a VERY well-respected dermatologist who specializes in skin cancers.  I have great faith in him.  Maybe it is because my husband's melanomas were found by ME (before we started going to this doctor) and he doesn't really think of him as a melanoma patient.  Husband has an unbelievable number of BCC that have been frozen, excised, recurred, treated again ... he gets at least ten biopsies each year and three or four Mohs procedures.  I'm wondering if the doctor is just so sure that eveyrthing is going to be BCC that he proceeds with the shaves without thinking.  Also -- maybe he is so sure in his mind that none of these to this point are melanoma, and if he was concerned he would punch or excise.  (He hasn't been wrong yet ... but I worry.)

Strength and Courage,


Anonymous - (4/20/2017 - 12:30pm)

are deep shaves ok?

Anonymous - (4/20/2017 - 12:40pm)

If a melanoma is ever suspected, a shave of any kind is not ok. There is NO way of knowing how deep the melanoma is going to be, therefore it is a huge risk to shave it, even deeply, as there is a chance it could bisect it and cause issues with knowing true depth.

A derm that is well practiced in skin cancers is very good at spotting a BCC from something else. My dad is like your husband, seems like every time he goes to his derm he's getting another BCC cut out or frozen. He goes to UCSF where I go and the derms there have dealt with so many cases of skin cancers, that I know his derm is doing what any top derm would do. So, hearing this, it doesn't worry me that much that your husband's derm is shaving when he sees it is a BCC. Especially since it is WAY more likely he will only have BCCs from now on and not another melanoma. If you do see a new mole on your husband that looks like his melanoma did, then let the derm know your suspicion and ask for a punch biopsy of it. 

Jenn - stage IV NED - Completed Ipi/Nivo (Yervoy/Opdivo) + surgery

Perhaps ask the doctor himself instead of the medical assistant. He very well may do it if you ask him to.

Good luck,


Home of the original "Crappy Shirt"

I've always heard that if it's suspicious, punch only. So I asked my derm. He's good, too.  He told me he "scoops" them???  And it's not a shave.



does that sound right?

"Scooping" would be shaving. The only other types are punch, which is pressed straight down with a round blade , no scooping motion, or excisional, which is excising with a scalpel like a small WLE. 

Jenn - stage IV NED - Completed Ipi/Nivo (Yervoy/Opdivo) + surgery