North Pacific Surgical AssociationEffect of biopsy type on outcomes in the treatment of primary cutaneous melanoma
Section snippets
Patient and tumor features
Data from patients with malignant melanoma referred for SLNB at the Oregon Health & Science University Division of Surgical Oncology from January 1998 to January 2012 was entered into a prospective database. From this database of 801 patients, 92 patients were excluded (8 younger than 18 years, 43 because the biopsy type or pathologic report was unclear, and 32 for other reasons [10 patients underwent incisional biopsy; 6 patients refused SLNB or were treated at another institution because of
Results
As shown in Table 1, excisional biopsy was the most common type of biopsy performed, and there were no significant differences in age, sex, or site of primary melanoma between the various biopsy groups, although median Breslow depth was slightly greater for patients who underwent excisional biopsy. Male patients tended to have deeper melanomas and were more likely to have primary lesions on the head and neck or trunk (P < .001). Female patients were more likely to have melanoma on the
Comments
Punch and shave biopsies were significantly associated with positive peripheral biopsy margins, and shave biopsy was associated with positive deep margins. Both were associated with residual tumor in the WLE and tumor depth upstaging on WLE. Punch biopsy was an independent predictor of larger WLE areas compared with shave and excisional biopsies. Biopsy type was not found to predict the accuracy, identification, or result of SLNB, or disease recurrence. Biopsy type was not a statistically
Conclusions
Both shave and punch biopsies demonstrated a significant risk for finding residual tumor in the WLE, with upstaging on WLE pathologic examination. Punch biopsy also led to a larger mean WLE area compared with other biopsy types. However, biopsy type did not impact SLNB accuracy or results, tumor recurrence, or DSS. Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of melanoma.
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Supported by the Elinor and Clayton Zeeb Trust and by the John D. Gray Clinical Melanoma Research Fund, which had no influence on the data collection or manuscript preparation.