Prospective study of pigmented lesions managed by shave excision with no deep margin transection of melanomas

Shao, E.; Blake, Tony; Po-Chao, Frank; Pool, Louis; Carew, Benjamin; Yong‐Gee, Simon; Wheller, Laura; De’Ambrosis, Brian; Muir, James

doi:10.1111/ajd.13312

Cited by 11 publications

(8 citation statements)

References 8 publications

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“… 1 Studies have reported higher rates of sampling error and misdiagnosis with partial biopsies, accounting for over 50% of false-negative melanoma misdiagnoses. 2 To tackle this issue, Robinson et al 3 adopted a similar adhesive tape technique previously described for margin mapping large lesions guided by RCM 4 to navigate a punch biopsy performed in a case of recurrent lentigo maligna; however, this method has several limitations, such as its applicability with handheld RCM and punch biopsies only, restricting its clinical utility. Furthermore, this method relies on the constant repositioning of the tape, which may be time consuming, negating the benefits of rapid handheld RCM evaluation.…”

Section: Discussionmentioning

confidence: 99%

Minimizing sampling error using a unique ink-stained reflectance confocal microscopy-guided biopsy technique to diagnose a large lentigo maligna

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Minimizing sampling error using a unique ink-stained reflectance confocal microscopy-guided biopsy technique to diagnose a large lentigo maligna

et al. 2022

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“…Partial shave biopsies may be appropriate for large tumours especially on the head and neck, distal limb or acral sites where large excisional biopsies may lead to unnecessary cosmetic or functional outcomes for some benign lesions. 3,[16][17][18][19] All partial shave biopsies of melanoma leave malignant melanocytes that will generally progress over time. The negative consequences of this growth may include disease progression, increased morbidity, decreased quality of life and shortened overall survival.…”

Section: Discussionmentioning

confidence: 99%

“…Although we cannot be certain that a correct diagnosis at the initial presentation would have prevented melanoma metastasis, the mean delay of more than 2 years before lesions were resampled to reach a correct diagnosis is concerning. Partial shave biopsies may be appropriate for large tumours especially on the head and neck, distal limb or acral sites where large excisional biopsies may lead to unnecessary cosmetic or functional outcomes for some benign lesions 3, 16–19 . All partial shave biopsies of melanoma leave malignant melanocytes that will generally progress over time.…”

Section: Discussionmentioning

confidence: 99%

The impact of incomplete clinical information and initial biopsy technique on the histopathological diagnosis of cutaneous melanoma

et al. 2021

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Background/Objectives: Increased rates of histopathological misdiagnosis of melanoma have been associated with incisional punch more so than shave biopsy when compared with complete excisional biopsy. It is unknown how the increasing utilisation of shave biopsy may impact melanoma diagnosis. The extent to which the provision of clinical information to the pathologist may improve diagnostic accuracy remains unclear. This study assessed the impact of both initial biopsy technique and provision of adequate clinical information to pathologists on the accuracy of histopathological diagnosis of melanoma and disease progression. Methods:We conducted a retrospective cohort with nested case-control study of all histopathological false-negative and false-positive melanoma diagnoses from January 2014 to May 2019 from the Victorian Melanoma Service electronic database. Cases were assessed for the initial biopsy type, provision of clinical information on pathology request forms and disease progression associated with falsenegative diagnosis.Results: Partial shave biopsy had higher odds of false-negative (OR 5.19, 95% CI 2.89-9.32; P < 0.001) and false-positive diagnoses (OR 1.95, 95% CI 1.45-2.63; P < 0.001) of melanoma when compared with elliptical excisional biopsy. These odds ratios were comparable with those found with incisional punch biopsy. Providing the suspected clinical diagnosis to pathologists also reduced the odds of false-negative diagnosis with melanoma progression by 3.8-fold (P = 0.02). Conclusion:The choice of initial biopsy technique and providing the suspected clinical diagnosis to pathologists are important for correct histopathological diagnosis of cutaneous melanoma and prevention of further disease progression.

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“…Shave procedures pose minimal cost and morbidity for patients. 25 Shaves are a quick, same-day procedure removing any risk of non-compliance. We suspect shave procedures result in a lower biopsy threshold leading to a more favourable in situ to invasive ratio.…”

Section: Number Needed To Biopsymentioning

confidence: 99%

Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance

et al. 2023

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Background/Objective Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Methods Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly‐selected patients. Results 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8–1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very‐high‐risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Conclusion Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease.

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Prospective study of pigmented lesions managed by shave excision with no deep margin transection of melanomas

Cited by 11 publications

References 8 publications

Minimizing sampling error using a unique ink-stained reflectance confocal microscopy-guided biopsy technique to diagnose a large lentigo maligna

Minimizing sampling error using a unique ink-stained reflectance confocal microscopy-guided biopsy technique to diagnose a large lentigo maligna

The impact of incomplete clinical information and initial biopsy technique on the histopathological diagnosis of cutaneous melanoma

Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance

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