Modified purse string closure for excisional biopsy of pigmented lesions on extremities

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


Proper selection of biopsy technique is imperative, especially when approaching a suspicious pigmented lesion on the extremity. When possible, a complete excisional biopsy with narrow margins is preferred to prevent partial sampling and inadequate evaluation of a lesion. A vertically oriented fusiform excisional biopsy is often selected for biopsy as it preserves lymphatics and prevents circumferential scarring. In this communication, we highlight possible pitfalls of selecting a fusiform ellipse for potential melanomas and provide a patient centered step-by-step guide to the use of narrow excisional biopsy with modified purse string closure. Purse string closure for biopsy of suspected melanoma is both tissue sparing at the time of biopsy and definitive excision. This approach also minimizes the possibility of interfering with lymphatic drainage should a sentinel lymph node biopsy be warranted. Although traditional purse string closures demonstrate similar cosmetic outcomes to secondary intention wounds, they allow for simplified wound care. The use of modifying dermal sutures allows for similar cosmetic outcomes to that of a linear excision.




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