If I’m doing a shave or a punch of a spot I’m concerned about–maybe squamous cell carcinoma or a basal cell carcinoma–it’s easy to know if the margins are positive you have to go back and treat it.
What do we do, though, if on the biopsy if it shows the margins were free or they were closely approaching the inked margins? My recommendation would be to go back and completely treat that and the reason is, we only see portions or sections of what you biopsy, so if we don’t see it go to margins, it’s very possible in another section it may actually extend to margins.
So I would recommend going back and treating them as you should treat them. Obviously you can do a destruction, you can treat it with chemotherapy. If you’re going to do a standard excision with 4mm margins that’s an option. Of course you can always do Mohs, depending on the location and indications.
Dr. Greg Wells, Dermatology Trained Dermatopathologist