Evaluating invasive cutaneous melanoma: Is the initial biopsy representative of the final depth?

Dermatologists, General Practitioners, and the Best Method to Biopsy Suspect Melanocytic Neoplasms

“…One study reported that shave and punch biopsies performed by experienced dermatologists underestimated the true lesion depth by approximately 8% and 20%, respectively, while complete excision determined the final melanoma depth in all cases. 5 Accordingly, the current American Academy of Dermatology (AAD) guidelines for the diagnosis of melanoma state as follows:…”

Non-Invasive Determination of Breslow Index

“…If a decision not to do a complete excision is made, partial biopsy specimens are usually taken from the most deeply pigmented, elevated, nodular, or other clinically suspect area. However, as a result of sampling error or a lack of correlation between the clinical and histological features, the portion biopsied may not be the most histologically representative portion of the lesion (Ng, Barzilai et al 2003). Ng et al (Ng, Barzilai et al 2003) found that in 95 of 108 initial shave or punch biopsies (88%), the physicians' clinical assessment of the melanoma for biopsy was accurate.…”

“…However, as a result of sampling error or a lack of correlation between the clinical and histological features, the portion biopsied may not be the most histologically representative portion of the lesion (Ng, Barzilai et al 2003). Ng et al (Ng, Barzilai et al 2003) found that in 95 of 108 initial shave or punch biopsies (88%), the physicians' clinical assessment of the melanoma for biopsy was accurate. A majority (84.8%) of the latter physicians were dermatologists with a median time of 11 years of post residency clinical experience.…”

Detecting both melanoma depth and volume in vivo with a handheld photoacoustic probe

“…3 The same group had earlier demonstrated that in the hands of experienced dermatologists, accuracy of tumor depth by partial biopsy was achieved in only 88% of samples, which is unacceptable for appropriate patient management. 4 In addition, in the current health care environment, many patients with dermatologic disease will be seen by physicians instead of by dermatologists, and the use of physician assistants is increasing: all of these contribute to a current trend, recognized several years ago, of inadequate technique and biopsy size estimations. 5 In sum, the surgeon is often faced with a treatment dilemma in the case of a partially biopsied melanoma -whether to plan a "definitive" surgery based upon a provisional measurement in the anticipation that the Breslow's depth measurement represents the thickest portion of the tumor, or perform an excisional biopsy of the entire remaining lesion to get an accurate measurement prior to definitive surgery.…”