Strategies for Identifying Biopsy Sites and Avoiding Wrong-Site Dermatologic Surgery

The talk focuses on preventing wrong-site dermatologic surgery by improving biopsy site identification. The speaker emphasizes that relying on patients or clinicians alone is unreliable, since patients and doctors may misidentify sites, and referrals often lack adequate photos or documentation. High-quality pre-biopsy clinical photographs are presented as the gold standard because they remove ambiguity, especially when the lesion is circled and captured with close-up and anatomical landmarks. If photos are unavailable, alternatives include body diagrams or web-based mapping tools to standardize lesion location, though these are less precise. Traditional dermoscopy can help localize recent or partial biopsy sites by identifying residual tumor or a pink healing scar, but it is limited when there are multiple scars or excisional biopsies. UV dermoscopy is described as a useful newer tool that can make recent biopsy sites appear darker and improve localization confidence, outperforming polarized dermoscopy in one study. Confocal microscopy is presented as a last-resort option that can detect residual tumor in selected cases, particularly for BCC. If the site still cannot be confidently identified, the recommendation is to stop, send the patient back to the referring clinician, and cancel surgery rather than risk operating on the wrong site. The key message is that good documentation—especially photos—prevents confusion, saves time, and avoids serious errors.