A meta‐analysis on the influence of partial biopsy of primary melanoma on disease recurrence and patient survival

Moscarella, Elvira; Pampena, Riccardo; Palmiotti, Giovanna; Bonamonte, Domenico; Brancaccio, Gabriella; Piccolo, Vincenzo; Longo, Caterina; Argenziano, Giuseppe

doi:10.1111/jdv.15903

Cited by 7 publications

(3 citation statements)

References 23 publications

(177 reference statements)

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“…12,13 A survey of family physicians in southwestern Ontario showed that if an excisional biopsy could not be performed, one-half of respondents would perform an incisional biopsy. 14 There is no evidence that incisional biopsy has an adverse effect on the prognosis of patients by transferring melanoma cells to skin lymphatics or blood vessels, 1,15,16 but incisional biopsy may affect the histological evaluation. Ng et al 17 found that up to 20% of initial partial biopsies were misleading because they underestimated the final Breslow depth of the melanoma.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Ultrasound‐Guided Incisional Biopsy Enhances the Pathological Accuracy of Incisional Biopsy of Cutaneous Melanoma

Wu²,

et al. 2022

J of Ultrasound Medicine

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Objectives-To assess the feasibility of preoperative ultrasound (US)-guided incisional biopsy through a prospective controlled clinical trial.Methods-This was a prospective, double-arm, single-center study of Chinese patients. Thirty patients were enrolled in the study. Fourteen patients received incisional biopsies for which the choice of biopsy area relied on a clinical evaluation, and 16 patients received incisional biopsies for which the choice of biopsy area relied on a US-guided evaluation. The following procedure was used in the US-guided incisional biopsy group: 1) clinical and dermoscopic evaluation of skin lesions; 2) US examination; 3) incisional biopsy; 4) surgical excision; and 5) histopathological examination. The same procedure was used in the non-USguided group except without US examination.Results-In the non-US-guided group, the mean tumor thicknesses obtained from incisional biopsy and postoperative histopathological examination were 2.1 and 4.1 mm, respectively. Seven melanomas were underestimated by incisional biopsy, resulting in margins narrower than currently recommended. In the USguided group, the mean tumor thicknesses obtained from US, incisional biopsy, and postoperative histopathological examination were 3.4, 2.9, and 2.7 mm, respectively. In only 3 melanomas was the tumor thickness of the incisional biopsy less than that of the postoperative histopathological examination, demonstrating that US-guided biopsy obtains the maximum thickness area.Conclusions-Preoperative US-guided incisional biopsy can enhance the pathological accuracy of incisional biopsy, which may allow us to better perform surgical excision with safe peripheral surgical margins.

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Section: Discussionmentioning

confidence: 99%

Preoperative Ultrasound‐Guided Incisional Biopsy Enhances the Pathological Accuracy of Incisional Biopsy of Cutaneous Melanoma

Wu²,

et al. 2022

J of Ultrasound Medicine

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“…Partial biopsies are not recommended and should be reserved for circumstances where a complete EB is impracticable [ 9 ]. The most common scenario where a partial biopsy is necessary is when the patient has a large lesion on the head, neck, hands, feet, anterior legs or genitalia.…”

Section: Biopsy Techniquementioning

confidence: 99%

Primary Cutaneous Melanoma—Management in 2024

Dixon,

Sladden,

Zouboulis

et al. 2024

JCM

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Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

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“…no visible tumour cells in the specimen margins upon histopathological examination ( 6 – 9 ). Although a recent meta-analysis has shown that incomplete excisions and partial punch biopsies of melanomas prior to their complete removal do not increase the recurrence risk or decrease survival rates ( 12 ), incompletely excised melanocytic lesions with any suspicion of melanoma should be considered a treatment failure. An incomplete excision of a non-dysplastic or low-grade dysplastic naevus does not require a re-excision ( 13 ), but if the patient develops a recurrent naevus it may mimic melanoma and lead to diagnostic difficulties in the future, as well as unnecessary re-excisions ( 14 , 15 ).…”

mentioning

confidence: 99%

Incomplete Excisions of Melanocytic Lesions: Rates and Risk Factors

Berglund¹,

Bäckman²,

Baldawi³

et al. 2021

Acta Derm Venereol

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Surgical excision of melanocytic lesions is a common procedure. Incomplete excisions cause unnecessary distress and may lead to further surgery. This study reveals that approximately 1 in 10 melanocytic lesions are incom pletely excised. Risk factors associated with higher incomplete excision rates are: naevi and melanomas in the head and neck area; surgery performed by general practitioners; punch excisions, and excisions of non-dysplastic naevi. Thus, larger surgical margins may be required in the head and neck area. Furthermore, general practitioners may need better surgical training in this procedure and updates on surgical guidelines. Lastly, the use of punch excisions for these lesions is not recommended.Incomplete excisions of melanocytic lesions occur despite the intention of complete removal. The aim of this study was to determine the incomplete excision rates for benign and malignant melanocytic lesions and the associated risk factors. Demographic, clinical, and histo pathological data possibly associated with incomplete excision were collected from 2,782 consecutive excisions between 2014 and 2015. Of these, 269 melanocytic lesions (9.7%) were incompletely excised. Multivariate analysis revealed the following risk factors for significantly higher incomplete excision rates: lesions located in the head and neck area (odds ratio (OR) 3.95, 95% confidence interval (95% CI) 2.35-6.65), surgery performed by general practitioners (OR 3.01, 95% CI 2.16-4.19), the use of a punch excision technique (OR 2.83, 95% CI 1.96-4.08), and excision of non-dysplastic naevi (OR 1.58, 95% CI 1.11-2.23). In conclusion, more caution should be taken when excising melanocytic lesions in the head and neck area, general practitioners require more surgical training, and punch excisions of melanocytic lesions should be avoided.

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A meta‐analysis on the influence of partial biopsy of primary melanoma on disease recurrence and patient survival

Cited by 7 publications

References 23 publications

Preoperative Ultrasound‐Guided Incisional Biopsy Enhances the Pathological Accuracy of Incisional Biopsy of Cutaneous Melanoma

Preoperative Ultrasound‐Guided Incisional Biopsy Enhances the Pathological Accuracy of Incisional Biopsy of Cutaneous Melanoma

Primary Cutaneous Melanoma—Management in 2024

Incomplete Excisions of Melanocytic Lesions: Rates and Risk Factors

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