Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis

Abstract

We performed a systematic review and meta-analysis to examine the relationship between the type of biopsy technique employed in the diagnosis of cutaneous melanoma and 4 clinically important outcomes: melanoma-specific mortality, all-cause mortality, Breslow tumor depth, or melanoma recurrence. Our database was obtained by searching PubMed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Library from inception until December 6, 2019. Studies were identified that compared biopsy techniques used to diagnose cutaneous melanoma with any of our study outcomes. We included 7 observational studies for our meta-analysis after screening 3231 titles and abstracts. Pooled data identified a significantly higher all-cause mortality in the punch biopsy group (risk ratio [RR], 1.520; P¼.02). A higher, but nonsignificant, rate of melanoma-specific mortality (RR, 1.96; P¼.22) and melanoma recurrence (RR, 1.20; P¼.186) was also found for the punch biopsy group. Breslow tumor thickness was not significantly lower for punch incision (standardized mean difference, À0.42; P¼.27). We found limited evidence for differences in clinically important outcomes across the spectrum of the most common methods employed in clinical practice for the initial diagnosis of cutaneous melanoma. A small, but significant, increase (P¼.02) in all-cause mortality with punch biopsies was not seen for the other outcomes and was most likely due to small sample sizes and demographic differences in the included studies and unlikely represents a clinically important outcome. Our findings support the use of existing clinical practice guidelines for evaluating pigmented lesions suspicious for cutaneous melanoma.

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

“…The data presented support the notion that shave biopsy is usually adequate to diagnose at least T1b or thicker lesions, and therefore the overall management of regional lymph node basins and thus melanoma-specific survival is unchanged. In their meta-analysis, Shellenberger et al compared punch biopsy with excision biopsy 35 and found no significant difference in Breslow thickness, melanoma recurrence, or melanoma-specific mortality. They reported a higher rate of all-cause mortality among the punch biopsy group (RR 1.5; p = 0.02); however, the authors noted that two of the three studies included in their meta-analysis were biased towards older patients in the punch biopsy group, which the authors felt may explain this finding.…”

Diagnosis and Management of Melanoma of the Scalp: A Review of the Literature

“…However, when lesions are extensive or excisional biopsy is not possible, incisional or punch biopsies or shave biopsies are reasonable alternative for establishing the diagnosis. 41 The diagnosis of scalp melanoma is usually possible on clinical and dermoscopy examination; however, a definitive diagnosis is confirmed on histopathological examination only. Dermoscopy and RCM can be very useful tools in making a clinically accurate diagnosis and eventually guide the selection of the best area to biopsy in case of large and extensive lesions.…”

Circulating miRNAs as biomarkers for the diagnosis in patients with melanoma: systematic review and meta-analysis

“…Dermoscopy is a technique that uses cross-polarized light and a magnifier placed on skin covered with liquid to see structures in the epidermis and superficial dermis that are not visible to the naked eye, thus allowing for better recognition of the signs of melanoma ( Ankad et al, 2020 ). If the lesion requires additional investigation, an incisional (partial) or excisional (complete) biopsy is performed for histology, with excisional biopsy being the standard of care ( Shellenberger et al, 2020 ).…”