North Pacific Surgical Association
Effect of biopsy type on outcomes in the treatment of primary cutaneous melanoma

Presented at the 99th Annual Meeting of the North Pacific Surgical Association, November 9–10, 2012, Spokane, WA.
https://doi.org/10.1016/j.amjsurg.2013.01.023Get rights and content

Abstract

Background

Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of choice for evaluating lesions suspected of being primary melanomas, other biopsy types are commonly used. We sought to determine the impact of biopsy type (excisional, shave, or punch) on outcomes in melanoma.

Methods

A prospectively collected, institutional review board–approved database of primary clinically node–negative melanomas (stages cT1–4N0) was reviewed to determine the impact of biopsy type on T-staging accuracy, wide local excision (WLE) area (cm2), sentinel lymph node biopsy (SLNB) identification rates and results, tumor recurrence, and patient survival.

Results

Seven hundred nine patients were diagnosed by punch biopsy (23%), shave biopsy (34%), and excisional biopsy (43%). Shave biopsy results showed significantly more positive deep margins (P < .001). Both shave and punch biopsy results showed more positive peripheral margins (P < .001) and a higher risk of finding residual tumor (with resulting tumor upstaging) in the WLE (P < .001), compared with excisional biopsy. Punch biopsy resulted in a larger mean WLE area compared with shave and excisional biopsies (P = .030), and this result was sustained on multivariate analysis. SLNB accuracy was 98.5% and was not affected by biopsy type. Similarly, biopsy type did not confer survival advantage or impact tumor recurrence; the finding of residual tumor in the WLE impacted survival on univariate but not multivariate analysis.

Conclusions

Both shave and punch biopsies demonstrated a significant risk of finding residual tumor in the WLE, with pathologic upstaging of the WLE. 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 disease-specific survival (DSS). Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of 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.

References (17)

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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.

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