Method of Biopsy and Incidence of Positive Margins in Primary Melanoma

Abstract

The presence of tumor at the lateral margin of punch biopsies is an expected result, since this method is often used to diagnose lesions with a large diameter. The presence of positive deep margins in 22% of shave biopsy specimens compromises the ability of this technique to properly stage patients.

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…The various techniques all have advantages and disadvantages. A shave biopsy is generally broader und allows for better evaluation of the epithelium, whereas a punch biopsy provides deeper sections of the corium [58,60,62].…”

Guidelines of care for the management of primary cutaneous melanoma

“…For a lesion clinically suspicious for cutaneous melanoma, one should ideally perform a narrow excisional biopsy that encompasses the entire breadth of the lesion with clinically negative margins to a depth sufficient to ensure that the lesion is not transected. [8][9][10][11][12][13][14][15][16][17][18] It has been suggested that 1-to 3-mm margins are required to clear the subclinical component of most atypical melanocytic lesions. 1,3,19 This can be accomplished in a number of ways including elliptical or punch excision with sutures, or shave removal to a depth below the anticipated plane of the lesion.…”

Biopsy of the pigmented lesion—When and how

“…Shave biopsy is by far the most common technique employed because of its rapidity and low cost as well as ease of wound care and an optimal cosmetic result. 32,[80][81][82][83] Another utility of the tangential technique is to allow for broad sampling of the lesion in question as opposed to incisional methods. A superficial shave removes mostly epidermis and at times superficial dermis.…”

“…80,94,[113][114][115][116] Regarding deep margins, concern has arisen over the accuracy of calculating the Breslow depth in shave biopsies. A retrospective analysis of 1784 cases in the 1990's showed that shave biopsy was superior to punch biopsy and curettage in allowing for evaluation of melanoma.…”