Primary melanoma: Pitfalls in diagnostic biopsy techniques and interpretations

Wagner, Donald E.; Cullen, Raymond A.

doi:10.1016/0002-9610(84)90295-2

Cited by 8 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,14 A significant proportion of biopsies in our study are inappropriate and inconsistent with the malignant melanoma guidelines. Punch biopsies are being performed even when the lesion is clinically suspected of being a malignant melanoma and suitable for excision biopsy.…”

Section: Discussionmentioning

confidence: 75%

Biopsy for Malignant Melanoma – Are We Following the Guidelines?

Tadiparthi

Panchani

Azhar

2008

annals

View full text Add to dashboard Cite

INTRODUCTION Guidelines for suspected malignant melanoma recommend a prompt, full-thickness excision biopsy allowing diagnosis and assessment of the Breslow thickness. Incisional biopsy is acceptable only for extensive facial lentigo maligna or acral melanoma. Punch, shave and other types of biopsies do not allow pathological staging and are, therefore, not recommended. PATIENTS AND METHODS A total of 100 referrals for histology-proven malignant melanoma were assessed retrospectively over a 1-year period (2005). RESULTS Of the 100 patients included in this study, 52 were male and 48 female. Ages ranged from 18–91 years, with a mean of 63 years. Origin of referrals was: dermatology, 63%; general practitioner (GP), 33%; and other sources in the remaining 4% of cases. Malignant melanoma was suspected in 84% and a benign lesion in remaining 16% of patients. However, only 56% of the patients were seen in our unit within 14 days of the referral as per the 2-week cancer rule. In these 100 patients, various types of biopsy were performed: 50 were referred without biopsy, 17 excision, 20 punch, 3 shave, 1 curettage, and 1 incisional biopsy. The type of biopsy was not recorded in the remaining 3 patients. Of the GP group, 48% were referred without biopsy, 12% had excision and 3% had incisional biopsies. The remaining 30% were punch, shave biopsies, and even curettage, inconsistent with current recommendations. Of the dermatology group, 54% were referred without biopsy, 21% underwent excision biopsy and 22% were punch biopsies. In total, 20 punch biopsies were performed, of which 7 were for lesions on the face ranging from 1.7–25 mm in size. The remaining punch biopsies were for lesions on the trunk or limbs (4–50 mm). Of the 20 punch biopsies performed, Breslow thickness was available in only 9 cases (45%). Sixteen of the punch biopsies were done when malignant melanoma was suspected and lesion otherwise was suitable for excisional biopsy. In the GP group, 3 shave biopsies and 1 curettage were performed, of which malignant melanoma was clinically suspected in one patient. The Breslow thickness was not obtained from any of the shave biopsies or curettage cases. Of the 17 excision biopsies performed, 3 were incompletely excised (2 by dermatology and 1 by GP). CONCLUSIONS A significant proportion of biopsies are inappropriate and inconsistent with the malignant melanoma guidelines. Punch biopsies are performed even when malignant melanoma is clinically suspected and excision biopsy is feasible. Only a small proportion of patients appear to be seen on an urgent basis within 14 days of referral. Such factors can lead to a delay in diagnosis, subsequent definitive treatment and adversely affect patient outcome. This study identifies a need to provide feedback and education to sources of malignant melanoma referrals.

show abstract

Section: Discussionmentioning

confidence: 75%

Biopsy for Malignant Melanoma – Are We Following the Guidelines?

Tadiparthi

Panchani

Azhar

2008

annals

View full text Add to dashboard Cite

show abstract

“…Nevertheless, it may provide more adequate tissue for diagnostic purposes 15 and reduce the need for a second definitive procedure if the lesion is not a melanoma. 16,17 On the other hand, SB is faster, requires less technical skill, and often does not require closure. It also offers the benefit of leaving less of a scar in the case of benign disease in conspicuous areas.…”

Section: Discussionmentioning

confidence: 99%

Does Shave Biopsy Accurately Predict the Final Breslow Depth of Primary Cutaneous Melanoma?

Moore

Hundley

et al. 2009

The American Surgeon™

View full text Add to dashboard Cite

Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively ( P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma ( P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.

show abstract

“…Thus, the physician not only failed to remove the tumor, but has excised otherwise normal skin and subjected the patient to an unnecessary surgery. As has been stated many times in the past, the shave biopsy is totally inappropriate when evaluating a lesion suspected of being a malignant melanoma 2 …”

Section: Discussionmentioning

confidence: 99%

“…Again, I wish to stress that appropriate selection of lesions is a critical point of this technique. It is unacceptable for lesions suspected to be malignant melanoma 2 or for dermatoses that may have a deep component 1 …”

Section: Discussionmentioning

confidence: 99%

The Vertical Wedge Biopsy

Gross¹

1992

The Journal of Dermatologic Surgery and Oncology

View full text Add to dashboard Cite

A biopsy technique is described that has been used in my clinical practice thousands of times. This very simple, cost-effective technique employs only one surgical tool, the scalpel blade, and permits a biopsy to be taken with sufficient tissue for histologic analysis. In that there is no disruption of a tumor margin, it permits the physician to make a diagnosis and not limit his or her choice of therapeutic modalities. Again, I wish to stress that appropriate selection of lesions is a critical point of this technique. It is unacceptable for lesions suspected to be malignant melanoma or for dermatoses that may have a deep component.

show abstract

Primary melanoma: Pitfalls in diagnostic biopsy techniques and interpretations

Cited by 8 publications

References 12 publications

Biopsy for Malignant Melanoma – Are We Following the Guidelines?

Biopsy for Malignant Melanoma – Are We Following the Guidelines?

Does Shave Biopsy Accurately Predict the Final Breslow Depth of Primary Cutaneous Melanoma?

The Vertical Wedge Biopsy

Contact Info

Product

Resources

About