Biopsy and Prognosis of Malignant Melanoma

Epstein, Ervin

doi:10.1001/jama.1969.03160080033007

Cited by 90 publications

(21 citation statements)

References 2 publications

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“…One of the first studies on this topic was published in 1969. 28 A total of 193 patients were recorded by the Califor- nian Tumor Registry, who were treated surgically between 1950 and 1954. Initial biopsies were performed in 115 patients, and 55 were radically excised.…”

Section: Is It Inadvisable To Partially Biopsy a Melanoma?mentioning

confidence: 99%

Dispelling myths concerning pigmented skin lesions

Piccolo

Russo

Giacomel³

et al. 2016

Acad Dermatol Venereol

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The history of medicine is replete with examples of debunked myths, and in daily clinical dermatological practice, we must still counter many misconceptions regarding pigmented lesions, both with patients and other medical practitioners. Debunking myths and attempting to explain the reasons for these erroneous beliefs are the purposes of this review. The literature review has been partially guided by the results obtained from an online questionnaire conducted on an Italian website (www.vediamocichiara.it) from February 15, 2015 to March 15, 2015. The remaining discussed were selected on the basis of the existing literature and our personal experience. In order to explore these misconceptions, the following are the seven most salient questions that require investigation: (i) Is it dangerous to excise moles?; (ii) Is it dangerous to traumatize moles?; (iii) Are plantar moles worrisome?; (iv) Is it necessary to selectively apply sunscreen to moles?; (v) Is it inadvisable to partially biopsy a melanoma?; (vi) Do moles turn into melanoma?; and (vii) Is it necessary to perform sentinel lymph node biopsy for thin melanomas and for atypical Spitz naevi? Myths are ubiquitous, being prevalent in dermatological practice, with many of them concerning pigmented skin lesions. By encouraging critical analysis by patients and medical practitioners, the birth and perpetuation of myths can potentially be minimized, for the ultimate benefit of patients. This requires a scientific approach to be rigorously applied to dermatology, with critical questioning of unsubstantiated hypotheses including those emanating from the mass media as well as from respected sources.

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Section: Is It Inadvisable To Partially Biopsy a Melanoma?mentioning

confidence: 99%

Dispelling myths concerning pigmented skin lesions

Piccolo

Russo

Giacomel³

et al. 2016

Acad Dermatol Venereol

View full text Add to dashboard Cite

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“…54,55 In the 1970s when the 'epidemic' of melanoma began, incisional biopsies were still considered to have an adverse effect on prognosis and, therefore, lesions suspected to be melanoma clinically were almost always excised completely. Once the adverse prognostic effect of incisional biopsies had been refuted, 56,57 that practice began to change, with increasing numbers of clinically suspicious pigmented lesions being excised incompletely. That tendency has been aggravated by an enhanced workload for dermatologists generated, in part, by public campaigns for early recognition of melanoma and by decreasing reimbursement rates for biopsies.…”

mentioning

confidence: 99%

The ‘epidemic’ of melanoma between under‐ and overdiagnosis

Weyers

2011

J Cutan Pathol

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In the past decades, the incidence of melanoma has been reported to rise in epidemic proportions. The chief reason for that pseudo-epidemic is improved criteria for diagnosis that allow melanomas to be recognized far more accurately and at earlier stages. The rising number of melanomas diagnosed has resulted in increased diagnostic scrutiny, more pigmented lesions being biopsied and more melanomas recognized, thus enhancing the 'epidemic' in self-perpetuating fashion. Regression of melanomas may, in part, explain why lesions undetected before did not result in a far higher mortality. Another potential reason for the disparity between increasing incidence of melanoma and relatively steady mortality may be overdiagnosis of melanoma. The latter may be curtailed by establishment of well-defined diagnostic categories, efforts to establish reliable criteria for recognition of those categories, better clinicopathologic correlation, postponement of biopsy of pigmented lesions in the case of irritation and excisional rather than incisional biopsies.

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“…Concern over local, regional, or systemic metastasis was prompted by prior studies and case reports which suggested a poor outcome for patients undergoing subtotal biopsy techniques. 87,[101][102][103][104][105][106][107][108][109][110][111][112] When comparing 14 patients who underwent incisional biopsy with 62 patients who had an excision for diagnosis in a retrospective study, Rampen, van Houten, and Jop 110 in 1980 were able to demonstrate reduced survival with incisional biopsy. However, they did not stratify for other factors related to survivability between the two groups.…”

Section: Margins and Metastasismentioning

confidence: 99%