# Situation: A 58-year-old man who has fished for a living since age 15 comes to the clinic because of a dark, irregular patch on the sole of his left foot. The provider plans an excisional biopsy with narrow margins rather than a shave biopsy. The client asks why. Which explanation is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629931  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 58-year-old man who has fished for a living since age 15 comes to the clinic because of a dark, irregular patch on the sole of his left foot.

The provider plans an excisional biopsy with narrow margins rather than a shave biopsy. The client asks why. Which explanation is accurate?

## 보기

1. It leaves a smaller scar than a shave biopsy would
2. It allows the full depth of the lesion to be measured **✔ 정답**
3. It keeps cancer cells from reaching the lymph nodes
4. It removes all the cancer, so no further surgery is needed

**정답: 2**

## 해설

For a suspected melanoma, an excisional biopsy with narrow margins removes the whole lesion so the pathologist can measure its full thickness (Breslow depth) and ulceration, the most important prognostic factors and the core of T staging. Wide local excision with margins based on that thickness follows if melanoma is confirmed.

## 심화 해설

Why the whole lesion is removed
A dark, irregular patch on the sole of the foot in a man with decades of outdoor work raises concern for melanoma. On the sole, this pattern is typical of acral lentiginous melanoma, the type not linked to sun exposure that is relatively more common in people with darker skin. For a suspected melanoma, the provider plans an excisional biopsy with narrow margins, removing the entire lesion. Removing the whole lesion allows the pathologist to measure its full thickness, the Breslow depth, which is the most important factor for staging and for planning further treatment.

Breslow depth and staging
The Breslow depth is the thickness of the tumor measured in millimeters from the top of the epidermis to the deepest tumor cell. Together with ulceration, it forms the core of the T category in melanoma staging and strongly predicts prognosis. A shave biopsy may cut through the base of the lesion, leaving the deepest part behind, so the true thickness cannot be measured and the tumor may be understaged. This is why excisional biopsy is preferred whenever a lesion is suspected to be melanoma.

| Statement | Assessment | Reason |
| --- | --- | --- |
| It leaves a smaller scar | Wrong | An excision usually leaves a larger scar than a shave |
| It allows the full depth to be measured | Correct | Breslow depth guides staging and treatment |
| It keeps cancer from reaching lymph nodes | Wrong | A biopsy is diagnostic, not preventive |
| It removes all the cancer | Wrong | Wide local excision usually follows |

What happens after the biopsy
If melanoma is confirmed, the client usually needs a wide local excision with margins chosen according to the measured thickness, and some clients are offered sentinel lymph node biopsy based on the stage. The diagnostic excision uses narrow margins so that it does not disturb lymphatic drainage before staging. Saying the biopsy removes all the cancer, or that it prevents lymph node spread, overstates what a diagnostic procedure can do.

Watch out! Use the ABCDE features when teaching skin checks: Asymmetry, Border irregularity, Color variation, Diameter larger than 6 mm, and Evolution. Remind clients to check the soles, palms, and nail beds, where acral melanoma occurs.

Exam takeaway
Key point! For suspected melanoma, an excisional biopsy is done so the full Breslow depth can be measured; thickness drives staging and the width of later excision. A shave biopsy risks cutting through the base of the tumor.

## 임상 시나리오

Excisional Biopsy for Suspected MelanomaWhy the full depth matters
A dark, irregular patch on the sole suggests acral lentiginous melanoma. An excisional biopsy with narrow margins removes the whole lesion.

The pathologist measures the Breslow depth and checks for ulceration, the key factors for staging and prognosis. A shave biopsy may cut through the base and understage the tumor.

If melanoma is confirmed, a wide local excision with margins based on thickness usually follows.

CautionA biopsy is diagnostic; it does not prevent spread and usually is not the final surgery.

## 핵심 개념

- **Melanoma** — A malignant tumor of melanocytes that can spread early and is staged mainly by tumor thickness.
- **Breslow depth** — The thickness of a melanoma in millimeters, the strongest predictor of prognosis and staging.
- **Excisional biopsy** — Removal of an entire lesion with a narrow margin so its full depth can be examined.
- **Acral lentiginous melanoma** — A melanoma type on the palms, soles, or nail beds that is not linked to sun exposure.
- **Wide local excision** — Surgical removal of a confirmed melanoma with a margin of normal skin chosen by tumor thickness.

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