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

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.