Shave Biopsy Is a Safe and Accurate Method for the Initial Evaluation of Melanoma

Abstract

BACKGROUND Shave biopsy of cutaneous lesions is simple, efficient, and commonly used clinically. However, this technique has been criticized for its potential to hamper accurate diagnosis and microstaging of melanoma, thereby complicating treatment decision-making. STUDY DESIGN We retrospectively analyzed a consecutive series of patients referred to the University of Florida Shands Cancer Center or to the Moffitt Cancer Center for treatment of primary cutaneous melanoma, initially diagnosed on shave biopsy to have Breslow depth < 2 mm, to determine the accuracy of shave biopsy in T-staging and the potential impact on definitive surgical treatment and outcomes. RESULTS Six hundred patients undergoing shave biopsy were diagnosed with melanoma from extremity (42%), trunk (37%), and head or neck (21%). Mean (± SEM) Breslow thickness was 0.73 ± 0.02 mm; 6.2% of lesions were ulcerated. At the time of wide excision, residual melanoma was found in 133 (22%), resulting in T-stage upstaging for 18 patients (3%). Recommendations for additional wide excision or sentinel lymph node biopsy changed in 12 of 600 (2%) and 8 of 600 patients (1.3%), respectively. Locoregional recurrence occurred in 10 (1.7%) patients and distant recurrence in 4 (0.7%) patients. CONCLUSIONS These data challenge the surgical dogma that full-thickness excisional biopsy of suspicious cutaneous lesions is the only method that can lead to accurate diagnosis. Data obtained on shave biopsy of melanoma are reliable and accurate in the overwhelming majority of cases (97%). The use of shave biopsy does not complicate or compromise management of the overwhelming majority of patients with malignant melanoma.

Compliance with guidelines in the surgical management of cutaneous melanoma across the USA

“…As treatment is dictated to a large extent by the supervising physician, these findings may reflect certain biases. Following the diagnosis of a 'good prognosis' melanoma with a biopsy, a wide local excision may be considered unnecessary, especially if the deep and radial margins of the biopsy are negative, as residual cancer may not be found in many cases [19]. This is a misconception; one of the tenets of melanoma care is that microscopic extension beyond the extent of visible pigmentation occurs commonly, as was shown by Olsen et al [20] in a classic study.…”

Clinical Presentation and Staging of Melanoma

“…Despite its frequent use among dermatologists and primary care physicians, partial biopsy performed via the shave technique has previously raised doubts regarding staging accuracy and histologic interpretation due to its ability to transect a segment of the lesion in question. Despite historical resistance, a properly performed shave biopsy is easy to execute, typically does not require cutaneous suturing, and can be quickly completed in a busy outpatient setting (14,16). A recently published, multi-institutional, retrospective study of 600 patients challenged decades of surgical dogma.…”

“…The authors conclude that partial biopsy is safe and should be performed by primary care providers and specialists alike. Therefore, it is reasonable to complete either excisional or partial biopsy when concerning lesions are encountered (16).…”

Current biopsy practices for suspected melanoma: A survey of family physicians in Southwestern Ontario

“…An incisional biopsy is quick, easy to perform, cost effective, associated with minimal morbidity and does not compromise longterm oncological outcomes for lesions determined to be malignant (5,14). The major disadvantage of incisional biopsies is a less reliable histopathological diagnosis (14).…”

“…A complete excisional biopsy may be difficult because of the level of surgical experience of the physician, cosmetic issues, tissue laxity and clinic operational time constraints. As an alternative, an incisional biopsy technique is acceptable for large lesions when excision is impractical or when the likelihood for melanoma is low (5). Although incisional biopsies may make the diagnosis of melanoma more challenging for pathologists and may occasionally be falsely negative due to sampling error, conducting a simple incisional biopsy rather than relegating a patient to a lengthy specialist wait for biopsy is an important step in detecting a melanoma earlier in its life cycle.…”