The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

Menezes, Sara Lee de; Kelly, John W.; Mar, Victoria

doi:10.5694/mja2.50502

Cited by 6 publications

(15 citation statements)

References 3 publications

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“…First, there may be incorrect classification of thickness categories. This could be due either to incorrect notifications to the Queensland Cancer Register, or to incorrect measurement; for example, if only a partial biopsy was used with base transection of the tumor, the true depth may have been thicker 9, 10 . Second, subsequent melanomas may be under‐reported, including melanomas of unknown primary.…”

Section: Discussionmentioning

confidence: 99%

Long‐term deaths from melanoma according to tumor thickness at diagnosis

Baade

Whiteman

Janda

et al. 2020

Intl Journal of Cancer

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There is little long-term follow-up information about how the number of melanoma deaths and case fatality vary over time according to the measured thickness of melanoma at diagnosis. This population-based longitudinal cohort study examines patterns and trends in case fatality among 44,531 people in Queensland (Australia) diagnosed with a single invasive melanoma (International Classification of Diseases for Oncology, third revision [ICD-O-3], C44, Morphology 872-879) between 1987 and 2011, including 11,883 diagnosed between 1987 and 1996, with up to 20 years follow-up (to December 2016). The 20-year case fatality increased by thickness, with the percentage of melanoma deaths within 20 years of diagnosis being up to 4.8% for melanomas with measured thickness <0.80 mm, 10.6% for tumors 0.8 to <1.0 mm and generally more than 30% for melanomas measuring 3 mm and more. For melanomas <1.0 mm, most deaths occurred between 5 and 20 years after diagnosis, whereas for thicker melanomas the reverse was true with most deaths occurring within the first 5 years. Five-year case fatality decreased over successive calendar time periods for melanomas <1.0 mm, but not for melanomas ≥1.0 mm. These findings demonstrate that the time course for fatal melanomas varies markedly according to tumor thickness at diagnosis. Improved understanding of the patient factors and characteristics of melanomas, in addition to tumor thickness, which increase the likelihood of progression, is needed to guide clinical diagnosis, communication with patients and ongoing surveillance pathways of patients with potentially fatal lesions.

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Section: Discussionmentioning

confidence: 99%

Long‐term deaths from melanoma according to tumor thickness at diagnosis

Baade

Whiteman

Janda

et al. 2020

Intl Journal of Cancer

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“…In a study of 853 patients with melanoma, Kaiser et al have shown that those diagnosed by shave biopsy were significantly more likely to be diagnosed with a thinner melanoma than those diagnosed by excision biopsy. 21 In this study, in the shave biopsy group, 77% of patients had T1, 15% had T2, and 7% had T3-4 melanomas, while in the excision biopsy group 57% had T1, 19% had T2, and 24% had T3-4 disease 27 These included eight patients who were upstaged from T1 melanoma (6% of total patients with T1 melanoma), eight who were upstaged from T2-3 (25% of total patients with T2-3 melanoma), and five who had their T4 melanomas upstaged (38% of total patients with T4 melanoma). Saco and Thigpen reported that 3/226 patients who were diagnosed with melanoma on shave biopsy had their T-stage increased following WLE.…”

Section: T Staging and Proportionate Change In T Stage Following Widementioning

confidence: 55%

“…The staging system utilized for determining T stage varied among the studies. The AJCC 6th edition was used by Hieken et al, 17 the 7th edition was used by Mills et al 18 and Saco and Thigpen, 20 and the 8th edition was used by Doolan et al 26 and De Menezes et al 27 In four studies, it was not specified which version of the AJCC was used. 9,12,22,25 T-stage upstaging following WLE was captured by eight studies (n = 1883).…”

Section: T Staging and Proportionate Change In T Stage Following Widementioning

confidence: 99%

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

et al. 2021

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Background Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous melanomas are diagnosed by shave biopsy. A systematic review was undertaken to investigate the impact of shave biopsy on tumor staging, treatment recommendations, and prognosis. Methodology The MEDLINE, Embase, and Cochrane Library databases were searched for relevant articles. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies. Results Fourteen articles from 2010 to 2020 were included. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed a positive deep margin in 42.9% of shave biopsies. Following WLE, change in tumor stage was reported in 7.7% of patients. Additional treatment was recommended for 2.3% of patients in the form of either further WLE and/or sentinel lymph node biopsy. There was high heterogeneity across studies in all outcomes. Four studies reported survival, while no studies found any significant difference in disease-free or overall survival between shave biopsy and other biopsy modalities. Conclusions Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin; however, this translated into a change in tumor stage or treatment recommendations in relatively few patients (7.7% and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed.

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“…The use of shave techniques to diagnose melanoma has increased progressively between 2005 and 2015 2 . The literature reports high rates of deep margin transection with use of this method of between 9 and 68% 3 .…”

Section: Introductionmentioning

confidence: 99%

“…1 The use of shave techniques to diagnose melanoma has increased progressively between 2005 and 2015. 2 The literature reports high rates of deep margin transection with use of this method of between 9 and 68%. 3 This occurs when the blade has transected the deep portion of the lesion, interfering with the ability to accurately measure tumour thickness.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Shave excision is a simple and cost-effective technique for the removal of suitable skin lesions. We performed a prospective study over six months, collecting data from pigmented lesions that were treated with shave excision by dermatologists. Only shave excisions with the intent to remove the lesion in toto were included. A total of 349 lesions were included in this study, 50 (14%) of these were melanomas and no melanoma diagnosed had deep margin involvement, while 13 (26%) had lateral margin involvement.

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The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

Cited by 6 publications

References 3 publications

Long‐term deaths from melanoma according to tumor thickness at diagnosis

Long‐term deaths from melanoma according to tumor thickness at diagnosis

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

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

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