Premium
Clinical impact of biopsy method on the quality of surgical management in melanoma
Author(s) -
Kaiser Sameer,
Vassell Rashida,
Pinckney Richard G.,
Holmes Todd E.,
James Ted A.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23580
Subject(s) - medicine , melanoma , biopsy , general surgery , surgery , radiology , cancer research
Background and Objectives Though guidelines recommend excisional biopsy for diagnosing melanoma, partial biopsy techniques are commonly performed, risking underestimation of Breslow depth and altering surgical management. Biopsy choice patterns by specialty and subsequent impact on surgical management was examined. Methods Retrospective review of the University of Vermont Cancer Registry. All patients with a single, primary cutaneous melanoma from 1/02 to 6/12 analyzed. Results Among 853 lesions analyzed, 606 had Breslow depth <1 mm. Dermatologists perform 62.6% of biopsies, favoring shave biopsies; surgeons favor excisional biopsies (48%), and primary care doctors favor punch biopsies (44.8%), ( P < 0.001). Final Breslow depth was upstaged in 107 (12.5%); however, only 23 of 488 partial biopsies (4.7%) displayed a discrepancy great enough to change surgical recommendations ( P < 0.001). There was no statistically significant relationship with presence of ulceration, regression, high Clark level, or high mitotic index. Conclusions Partial biopsy techniques are commonly performed in diagnosing melanoma; especially among dermatologists, who perform the majority of biopsies. Though partial biopsies were less accurate in determining Breslow thickness; they rarely alter recommendations for surgical management. Predictive features could not be determined to identify the few cases where a Breslow discrepancy was clinically relevant. J. Surg. Oncol. 2014 109:775–779 . © 2014 Wiley Periodicals, Inc.