Abstract
Introduction
Effective treatment of malignant melanomas is dependent upon accurate histopathological
staging of preoperative biopsy specimens. While narrow excision is the gold standard
for melanoma diagnosis, superficial shave biopsies have become the preferred method
by dermatologists but may transect the lesion and result in inaccurate Breslow thickness
assessment. This is a retrospective cohort study evaluating an initial method of biopsy
for diagnosis of cutaneous melanoma and indication for reoperation based on inaccurate
initial T-staging.
Methods
We retrospectively analyzed consecutive patients referred to the Medical College of
Wisconsin, a tertiary cancer center, with a diagnosis of primary cutaneous melanoma.
Adult patients seen between 2015 and 2018 were included. Fisher's exact test was used
to assess the association between method of initial biopsy and need for unplanned
reoperation.
Results
Three hundred twenty three patients with cutaneous melanoma from the head and neck
(H&N, n = 101, 31%), trunk (n = 90, 15%), upper extremity (n = 84, 26%), and lower extremity (n = 48, 28%) were analyzed. Median Breslow thickness was 0.54 mm (interquartile range = 0.65).
Shave biopsy was the method of initial biopsy in 244 (76%), excision in 23 (7%), and
punch biopsy in 56 (17%). Thirty nine (33%) shave biopsies had a positive deep margin,
as did seven (23%) punch biopsies and 0 excisional biopsies. Residual melanoma at
definitive excision was found in 131 (42.5%) of all surgical specimens: 95 (40.6%)
shave biopsy patients, 32 (60.4%) punch biopsy patients, and four (19.0%) excision
biopsy patients. Recommendations for excision margin or sentinel lymph node biopsy
changed in 15 (6%) shave biopsy patients and five (9%) punch biopsy patients.
Conclusions
Shave biopsy is the most frequent method of diagnosis of cutaneous melanoma in the
modern era. While shave and punch biopsies may underestimate true T-stage, there was
no difference in need for reoperation due to T-upstaging based on initial biopsy type,
supporting current diagnostic practices. Partial biopsies can thus be used to guide
appropriate treatment and definitive wide local excision when adjusting for understaging.
Keywords
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References
- The impact of incomplete clinical information and initial biopsy technique on the histopathological diagnosis of cutaneous melanoma.Australas J Dermatol. 2021; 62: e524-e531
- NCCN clinical practice guidelines in oncology.Cutan Melanoma Version 3. 2022;
- LBA3_PR–Pembrolizumab versus placebo after complete resection of high-risk stage II melanoma: efficacy and safety results from the Keynote 716 double-blinded phase III trial.Ann Oncol. 2021; 32: S1283-S1346
- Diagnosis and management of cutaneous melanoma.Australian journal of general practice. 2020; 49: 733-739
- Guidelines of care for the management of primary cutaneous melanoma.J Am Acad Dermatol. 2019; 80: 208-250
- ESMO consensus conference recommendations on the management of locoregional melanoma: under the auspices of the ESMO Guidelines Committee.Ann Oncol. 2020; 31: 1449-1461
- Clinical impact of biopsy method on the quality of surgical management in melanoma.J Surg Oncol. 2014; 109: 775-779
- Cutaneous melanoma: methods of biopsy and definitive surgical excision.Dermatol Ther. 2005; 18: 387-393
- Impact of biopsy technique on clinically important outcomes for cutaneous melanoma: a systematic review and meta-analysis.Mayo Clin Proc: Innovations, Quality & Outcomes. 2020; 4: 373-383
- Shave biopsy is a safe and accurate method for the initial evaluation of melanoma.J Am Coll Surgeons. 2011; 212: 454-460
- Impact of shave biopsy on diagnosis and management of cutaneous melanoma: a systematic review and meta-analysis.Ann Surg Oncol. 2021; 28: 6168-6176
- Melanoma staging: American joint committee on cancer (AJCC) and beyond.Ann Surg Oncol. 2018; 25: 2105-2110
- Does shave biopsy accurately predict the final Breslow depth of primary cutaneous melanoma?.The Am Surgeon. 2009; 75: 369-373
- Cutaneous melanoma, version 2.2019, NCCN clinical practice guidelines in oncology.J Natl Compr Cancer Netw. 2019; 17: 367-402
- Does biopsy type influence survival in clinical stage I cutaneous melanoma?.J Am Acad Dermatol. 1985; 13: 983-987
- Impact of biopsy modality on the management of cutaneous melanoma of the head and neck.Otolaryngology-Head Neck Surg (Tokyo). 2018; 158: 473-478
- Non-radical diagnostic biopsies do not negatively influence melanoma patient survival.Ann Surg Oncol. 2007; 14: 1424-1430
- Frequency of and risk factors for tumor upstaging after wide local excision of primary cutaneous melanoma.J Am Acad Dermatol. 2017; 77: 341-348
- Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists.Hum Pathol. 1996; 27: 528-531
- Inter-observer variation in the histopathological diagnosis of clinically suspicious pigmented skin lesions.The J Pathol A Journal of the Pathological Society of Great Britain and Ireland. 2002; 196: 459-466
Article info
Publication history
Published online: February 03, 2023
Accepted:
December 14,
2022
Received in revised form:
November 30,
2022
Received:
March 17,
2022
Identification
Copyright
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