Response

We thank Drs Montgomery and Sadler for their well-researched response to our teaching video on punch biopsy. We certainly agree in principle that excisional biopsy is the standard of care for sampling suspicious pigmented lesions and would like to remind readers that our teaching series focuses on technique rather than management issues.

It would also be interesting to analyze the differing capacities to deal with pigmented lesions within other national health care systems. Within our current system in Canada, lack of capacity is such that our primary care–based surgical clinic sometimes obtains referrals from dermatologists to aid with the volume of minor procedures. Although we are comfortable with excisional biopsy, not all family physicians have the necessary tools to routinely complete this procedure; however, they might be adequately set up to perform punch biopsies.

We agree that the recommended approach to suspicious pigmented lesions should be full excision, and we should work toward assuring that our health care system can accommodate this recommendation.

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