BIOPSY SCARS
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                    I would like to ask the members how often they feel scarring
occurs  after a shave biopsy  of melanocytic nevus.  Do you feel it may be
possible to perform a shave biopsy on a cosmetically sensetive area , such as
the face, without causing a scar by attempting leave the dermis intact when
doing the biopsy?   I would really be interested in your replies

Sharon Fried MD.
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I shave almost every benign nevus using a gillette blade.  Incidnce 
of scarring is very low ( I have had two hypertrophic scars on the 
trunk in the past 8 years, both of which responded to K10).  It heals 
in 5-8 days using bacitracin oint and an H2O2 swab rolled, not scrubbed, 
over it qd.  It stays red for 3wweks to 3 months and then looks like 
surrounding skin.  Reccurence rates on the nevi is about 2.5%.

Daniel Siegel
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An excellent way to avoid scarring, especially on the face, is to very, very, 
lightly electrodesiccate the rim of epidermis around the shave site, and then 
gently curette this rim.  This helps blend the shave very nicely into the 
surrounding skin when it heals!

Jere J. Mammino, D.O.
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I've been using the "Blue Blade technique" for over 2 decades (!), and
have found it extremely satisfying.  If done properly the scarring is
minimal (there is, after all, always <underline>some</underline> scar if
you go below the dermal-epidermal boundary), but in many cases
(especially when the lesion is not pigmented) I can't even
<underline>find</underline> the area of removal.  That's why many times I
take a Polaroid picture after the procedure, and put in it the chart so
that I can find the removal site.  On the trunk and limbs you do get more
scarring, and I've certainly had my share of hypertrophic scars, which
decrease with time or (occasionally) require IL steroid.  If the lesion
is large or "cosmetically important" I always take a Polaroid for the
chart.  After healing is complete it's nice to be able to show the
patient the "before" picture, since several years later neither the
patient or I can find the removal site.  How quickly we all forget!  
I've been using very light C+D for years with very good
results.  It really decreases "shadowing".  I often do it after the
patient sits up, since this will sometimes reveal a "lip" at the site. 
The key, remember, is to do the Rx very gently.

Robert I. Rudolph, M.D., FACP
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IMO a shave biopsy to the depth of the reticular dermis leaves a scar
virtually always. Patients always want to know "will there be a scar?" and
the answer is "yes,  but usually it will not be very noticeable."   Many
factors influence the amount of scar tissue including but not limited to
infection, the depth into the dermis of the biopsy, hemostatic method, the
location, the individual healing properties of the patient, the type of wound
care, etc.      

Walter H Wood, M.D.
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I think it is impossible to do a shave excision of a nevus with a dermal
component without some scarring .  This can be minimized with proper occlusive
wound care. (This doesn't necessarily seem logical, since one can dermabrade
into the upper dermis without resultant scarring.) 

Philip Hughes, M.D.
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A scar always results from a shave biopsy, but 75% or more of the time it's
not significant. Light curettage of the border (sometimes preceded by
desiccation) usually helps the resultant scarring. This can be done right
after the shave is performed.

gary salenger
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