Dermatologists, General Practitioners, and the Best Method to Biopsy Suspect Melanocytic Neoplasms

Marghoob, Ashfaq A.; Terushkin, Vitaly; Dusza, Stephen W.; Busam, Klaus J.; Scope, Alon

doi:10.1001/archdermatol.2010.15

Cited by 11 publications

(6 citation statements)

References 35 publications

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“…4,5,13,14,22-24 Ng and colleagues 4 reported increased odds of misdiagnosing melanomas with punch (odds ratio [OR] 16.6, 95% CI 10 to 27, p < 0.001) and shave biopsies (OR 2.6, 95% CI 1.2 to 5.7, p = 0.02) when compared with excisional biopsy, and an increased odds of microstaging inaccuracy when punch (OR 5.1, 95% CI 3.4 to 7.6, p < 0.001) and shave biopsies (OR 2.3, 95% CI 1.5 to 3.6, p < 0.001) were compared with excisional biopsies.…”

Section: Discussionmentioning

confidence: 99%

Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

Zager

Hochwald

Marzban

et al. 2011

Journal of the American College of Surgeons

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BACKGROUND Shave biopsy of cutaneous lesions is simple, efficient, and commonly used clinically. However, this technique has been criticized for its potential to hamper accurate diagnosis and microstaging of melanoma, thereby complicating treatment decision-making. STUDY DESIGN We retrospectively analyzed a consecutive series of patients referred to the University of Florida Shands Cancer Center or to the Moffitt Cancer Center for treatment of primary cutaneous melanoma, initially diagnosed on shave biopsy to have Breslow depth < 2 mm, to determine the accuracy of shave biopsy in T-staging and the potential impact on definitive surgical treatment and outcomes. RESULTS Six hundred patients undergoing shave biopsy were diagnosed with melanoma from extremity (42%), trunk (37%), and head or neck (21%). Mean (± SEM) Breslow thickness was 0.73 ± 0.02 mm; 6.2% of lesions were ulcerated. At the time of wide excision, residual melanoma was found in 133 (22%), resulting in T-stage upstaging for 18 patients (3%). Recommendations for additional wide excision or sentinel lymph node biopsy changed in 12 of 600 (2%) and 8 of 600 patients (1.3%), respectively. Locoregional recurrence occurred in 10 (1.7%) patients and distant recurrence in 4 (0.7%) patients. CONCLUSIONS These data challenge the surgical dogma that full-thickness excisional biopsy of suspicious cutaneous lesions is the only method that can lead to accurate diagnosis. Data obtained on shave biopsy of melanoma are reliable and accurate in the overwhelming majority of cases (97%). The use of shave biopsy does not complicate or compromise management of the overwhelming majority of patients with malignant melanoma.

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Section: Discussionmentioning

confidence: 99%

Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

Zager

Hochwald

Marzban

et al. 2011

Journal of the American College of Surgeons

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“…punch biopsy, shave biopsy, incisional biopsy) should be generally avoided as they are associated with an increased risk of melanoma misdiagnosis compared with complete excisional biopsy. Notably, incomplete biopsy of melanoma, misdiagnosis of nodular melanoma by a pathologist and melanoma misdiagnosed as ‘dysplastic naevus involving margins’ by a pathologist 4 are among the top seven melanoma malpractice claims in the U.S.A 17,18 . Thus, if a tumour is excised for a diagnostic purpose, the best strategy, if feasible, should be complete excision.…”

Section: Discussionmentioning

confidence: 99%

Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study

Longo

Moscarella²,

Pepe³

et al. 2011

British Journal of Dermatology

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“…Diagnostic accuracy, a common focus, was assessed predominantly by comparing GPs diagnosis (either visually or tool‐assisted) with histopathological 71 or dermatologist diagnosis 75 . The proportion of partial versus full excision biopsies has been proposed of a measure of care quality, but its usefulness has been questioned, suggesting the need for further development 103,104 …”

Section: Discussionmentioning

confidence: 99%

“…75 The proportion of partial versus full excision biopsies has been proposed of a measure of care quality, but its usefulness has been questioned, suggesting the need for further development. 103,104 Delays in care were assessed by examining lead times between initial contact to diagnosis and treatment, to identify where care can be improved, particularly for patients with more advanced skin cancer. 81 Caution is needed, however, as lead times may also reflect the time needed to engage family in treatment planning, and to manage complex patients, factors which must be controlled for when comparing delays in care.…”

Section: Quality Measurementmentioning

confidence: 99%

Measuring the quality of skin cancer management in primary care: A scoping review

et al. 2023

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Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.

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Dermatologists, General Practitioners, and the Best Method to Biopsy Suspect Melanocytic Neoplasms

Cited by 11 publications

References 35 publications

Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study

Measuring the quality of skin cancer management in primary care: A scoping review

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