Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma

Mills, Jane K.; White, Ian; Diggs, Brian S.; Fortino, Jeanine; Vetto, John T.

doi:10.1016/j.amjsurg.2013.01.023

Cited by 56 publications

(73 citation statements)

References 11 publications

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“…In our series of 134 melanomas with complete thickness data available, 25% of melanomas diagnosed by shave biopsy were upstaged from <1 mm to >1 mm thickness compared with 3% diagnosed by punch biopsy and 4% by excisional biopsy, which could have influenced the potential to discuss the role of sentinel node biopsy in these patients. These findings are slightly at variance with the Oregon series, where the T stage changed after a punch biopsy in 23%, after a shave biopsy in 8% and after excision in 2%, and in particular in 13% of melanoma diagnosed by punch or shave biopsies, measured thickness changed from <1 mm to >1 mm . Countering these data, a study assessing shave biopsy in 490 patients in a Texas Veterans' hospital found the T stage to be appropriately assessed in 99% of patients when only 14% of patients had an excision biopsy, mostly for thicker lesions (mean 2.28 mm) compared with a mean thickness of <1 mm for punch and shave biopsied lesions.…”

Section: Discussionmentioning

confidence: 68%

Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia

Smithers

Hughes

Beesley

et al. 2015

Journal of Surgical Oncology

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Background Knowledge of variation in diagnosis and surgery in high‐risk primary melanoma patients is limited. We assessed frequency and determinants of diagnostic procedures, wide local excision (WLE) and sentinel lymph node biopsy (SLNB). Methods People in Queensland newly diagnosed with melanoma, clinical stage 1b or 2, were recruited prospectively. Patient information was collected from questionnaires and pathology records. Differences in surgical procedures in relation to host and tumor characteristics were assessed. Results In 787 participants, primary melanoma was diagnosed by surgical excision (74%), shave (14%), punch (12%) or incisional (1%) biopsy. General practitioners (GPs) diagnosed 80%. Diagnostic procedure differed by remoteness of residence, health sector, treating doctor's specialty and melanoma site and thickness. 766 patients had WLE, 86% by surgeons. Of 134 residual melanomas, 13 (10%) were ≤ 1 mm at diagnosis but > 1 mm at WLE, mostly after shave biopsy. SLNB was performed in 261 (33%) patients. SLNB was more common in those under 50, in remoter locations or treated by GP initially, and less common with head and neck melanoma. Conclusion Diagnostic and surgical procedures for primary melanoma vary substantially and partial biopsy can influence initial tumor microstaging. Patient, tumor and doctor characteristics influence SLNB practice. J. Surg. Oncol. 2015; 112:359–365. © 2015 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 68%

Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia

Smithers

Hughes

Beesley

et al. 2015

Journal of Surgical Oncology

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“…conducted a similar study investigating the effects of biopsy types on outcomes in the treatment of primary cutaneous melanoma. The authors found an SLNB accuracy percentage of 98.5 and were not affected by biopsy type (shave, punch, excisional, and incisional) . Similarly, the biopsy type did not demonstrate a survival advantage or impact on tumor recurrence.…”

Section: Discussionmentioning

confidence: 89%

“…The authors found an SLNB accuracy percentage of 98.5 and were not affected by biopsy type (shave, punch, excisional, and incisional). 19 Similarly, the biopsy type did not demonstrate a survival advantage or impact on tumor recurrence. These results are similar to our findings that biopsy type does not seem to change melanomaspecific survival or overall survival.…”

Section: Discussionmentioning

confidence: 92%

Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck

et al. 2019

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Background Previous wide local excision prior to sentinel lymph node biopsy (SLNB) may have the potential to disrupt lymphatic channels, thus incorrectly identifying the sentinel node. The purpose of this study was to investigate: (1) regional recurrence rates of prior wide local excision compared to other biopsy techniques and (2) survival outcomes in patients with melanoma of the head and neck. Methods Between the years 2000 and 2016, 391 cases were reviewed with a median follow‐up time of 30 months in a large tertiary care center. Biopsy practices included shave, punch, wide local excision, and narrow margin excisional/Mohs, and associations with time to local or regional relapse and death from melanoma were evaluated. Main outcomes included identification of sentinel lymph nodes, overall survival, and melanoma‐specific survival. Results Of the 391 patients, biopsy patterns were as follows: 77 (19%) unknown biopsy, 30 (8%) prior wide local excision (WLE), 105 (27%) narrow margin excisional biopsy, 69 (18%) punch biopsy, and 110 (28%) shave biopsy. SLNB was successfully identified in all 30 patients whom had a prior WLE. There were 50 regional recurrences in the neck and 27 local recurrences with the median (IQR) at 1.2 years and 1.0 years, respectively. Multivariable associations of type of prior biopsy, depth of invasion, and nodal status with time to regional recurrence, local recurrence, overall survival, and melanoma‐specific survival were not significantly different. Conclusions Sentinel lymph node biopsy for melanoma of the head and neck can be successfully performed in patients after previous wide local excision.

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“…1 Our analysis has some limitations; in particular, the majority of the studies were retrospective and follow-up time was not uniform among studies and not always reported. However, it has to be underlined that non-excisional biopsies should be performed only in exceptional cases, as partial biopsies carry a higher risk of misdiagnosis and a possible underestimation of Breslow's thickness.…”

Section: Discussionmentioning

confidence: 90%

“…[1][2][3] With primary excisional biopsy, the entire specimen is available for histopatologic examination, allowing accurate evaluation of lesion's architecture, Breslow's thickness and excision margins. [1][2][3] With primary excisional biopsy, the entire specimen is available for histopatologic examination, allowing accurate evaluation of lesion's architecture, Breslow's thickness and excision margins.…”

Section: Introductionmentioning

confidence: 99%

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

Moscarella

Pampena

Palmiotti

et al. 2019

Acad Dermatol Venereol

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Background Complete surgical excision is the preferred biopsy type for suspicious melanocytic lesions. However, partial biopsy is sometimes used in special situations. Previous studies have explored the effect of partial biopsy of a primary melanoma on patient outcome with controversial results. Objective We performed a meta‐analysis on the influence of the type of biopsy of a primary melanoma on recurrence‐free survival (RFS) and melanoma‐related survival (MRS). Methods Clinical trials, observational cohort studies and case–control studies reporting absolute number of recurrences and/or melanoma‐related deaths in patients undergoing a partial or excisional biopsy of melanoma were included in the meta‐analysis. Results In all, the five included studies reported 3249 patients, 1121 (34.5%) of them in the partial biopsy group and 2128 (65.5%) in the excisional biopsy group. Despite a trend in favour of excisional biopsy in reducing the risk for recurrences, the forest plot related to RFS failed to demonstrate significant differences among groups (RR: 1.27; 95% CI 0.97–1.67; P: 0.09; random effects; I2: 55%). The forest plot showed no difference in the risk of dying for melanoma‐related causes for patients undergoing partial biopsy vs. excisions biopsy (RR: 1.50; 95% CI 0.98–2.30; P: 0.06; random effects; I2: 60%). Limitations The majority of the studies were retrospective, and follow‐up time was not uniform among studies and not always reported. Conclusion In conclusion, a partial biopsy can be performed in special situations, such as large primary tumours located in surgically sensitive areas, without altering MRS and RFS.

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Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma

Cited by 56 publications

References 11 publications

Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia

Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia

Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck

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

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