Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy

Bolshinsky, Vladimir; Lin, Min; Serpell, Jonathan; Leung, Michael; Wolfe, Rory; McLean, Catriona; Kelly, John W.

doi:10.1016/j.jaad.2015.08.065

Cited by 23 publications

(9 citation statements)

References 16 publications

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“…Following a partial biopsy with transection of a radial or deep margin, residual melanoma is often found on wider excision . Bolshinky and colleagues showed following apparently complete excisional biopsy, 3.6% of WLEs had residual melanoma with a third of these cases requiring a second (three‐stage) or third (four‐stage) excision . Other studies have found similar, 2% rates of additional surgery following excisional biopsy and 2–5% rates of additional surgery following shave biopsy …”

Section: Introductionmentioning

confidence: 94%

“…The impact of partial biopsies on the total number of procedures for definitive surgical management is unknown. Following a partial biopsy with transection of a radial or deep margin, residual melanoma is often found on wider excision . Bolshinky and colleagues showed following apparently complete excisional biopsy, 3.6% of WLEs had residual melanoma with a third of these cases requiring a second (three‐stage) or third (four‐stage) excision .…”

Section: Introductionmentioning

confidence: 99%

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Think before you shave: Factors influencing choice of biopsy technique for invasive melanoma and effect on definitive management

et al. 2019

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Background/Objective: Partial biopsies are sometimes used for melanoma diagnosis with anticipated time and cost savings compared to excisional biopsy. However, their impact on subsequent melanoma management is unknown. Determine factors related to choice of partial over excisional biopsy to diagnose invasive melanoma and examine the effect of partial biopsies on definitive melanoma management. Method:Retrospective repeated cross-sectional population-based study through the Victorian Cancer Registry of diagnosed melanomas in 2005, 2010 and 2015. A random sample of 400 patients per year, stratified by tumour thickness, was selected.Results: A total of 1200 patients had 833 excisional and 337 partial biopsies. Omission of suspected diagnosis on pathology requests affected 46% (532/1151) of all diagnostic biopsies. Diagnostic suspicion did not influence preference for partial over excisional biopsy [Odds Ratio (OR) 1.2, 95%CI 0.8-1.7; P = 0.40]. The partial:excisional biopsy usage ratio was higher in patients aged > 50 years than patients aged <50 years [relative risk ratios (RRR) 1.5; 95%CI 1.0 to 2.2; P = 0.03]. In 34% and 17% of tumours diagnosed with punch and shave, respectively, three procedures were required for definitive excision instead of two, compared with 5% of excisional biopsies When partial biopsy was used, patients were at greater risk of requiring three-staged excisions when controlled for age, anatomical site, melanoma subtype and thickness (RRR 6.7; 95%CI 4.4-10.1; P < 0.001). Conclusion: Diagnostic suspicion does not appearto be a major factor influencing choice of biopsy technique. Using partial biopsy to diagnose melanoma often leads to an extra procedure for definitive treatment compared with excisional biopsy.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Think before you shave: Factors influencing choice of biopsy technique for invasive melanoma and effect on definitive management

et al. 2019

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“…42,43 A recent study examining the frequency of residual melanoma in WLE specimens after complete excisional biopsy demonstrated that LM and LMM were the most at-risk subtypes. 44 Furthermore, when body location was examined, it was found that the head and neck location was most at risk of having residual melanoma post-WLE. 44 Interestingly, amelanosis was not significantly associated with residual disease.…”

Section: Discussion and Reviewmentioning

confidence: 99%

Amelanotic Lentigo Maligna Melanoma: Mohs Surgery as the Definitive Treatment of an Invisible Tumour

2017

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Amelanotic lentigo maligna melanoma represents <2% of melanomas. Diagnosis is delayed owing to the lack of lesion pigmentation and advanced disease at presentation. Excision with appropriate margins is the treatment standard, but the starting point for such margins is often unclear. We describe 2 patients with amelanotic melanoma treated by Mohs micrographic surgery (MMS) that would not have been cleared by wide local excision alone and provide an extensive review of the literature. Both patients presented with histologic diagnoses of malignant melanoma, one with a barely perceptible biopsy site scar on the left infraorbital cheek/lower eyelid (Breslow 1.8 mm) and the second with an amelanotic tumour on the right helix (Breslow 10 mm). Due to location, aggressive histology, amelanotic appearance, and no apparent surrounding skin surface changes, MMS was elected to maximise margin control. For patient 1, invasive and in situ tumour was found at the American Joint Committee on Cancer-recommended margin of 1.5 cm, and the final defect measured 8.5 × 4.8 cm. Patient 2 had a significant invasive and amelanotic lentigo maligna component, resulting in a 9.0 × 6.5-cm defect. MMS allows for immediate histologic feedback on tumour margins of a clinically invisible tumour and thus offers the most definitive treatment.

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“…LM has the highest risk of residual disease and highest recurrence rate of all melanoma subtypes after surgical excision [75]. RCM allows detection and delineation of subclinical tumor extension [42,76,77,42].…”

Section: Background: Reflectance Technologymentioning

confidence: 99%

Advances in the use of Reflectance Confocal Microscopy in Melanoma

2018

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In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology ex vivo.

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Frequency of residual melanoma in wide local excision (WLE) specimens after complete excisional biopsy

Cited by 23 publications

References 16 publications

Think before you shave: Factors influencing choice of biopsy technique for invasive melanoma and effect on definitive management

Think before you shave: Factors influencing choice of biopsy technique for invasive melanoma and effect on definitive management

Amelanotic Lentigo Maligna Melanoma: Mohs Surgery as the Definitive Treatment of an Invisible Tumour

Advances in the use of Reflectance Confocal Microscopy in Melanoma

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