Ramya Vangipuram, Mary Ramirez, Yasir Al Abboodi and Subhasis Misra
Background: Various biopsy types are used to diagnose melanoma, after which wide local excision (WLE) is the gold standard for treatment. Depending on the final pathology report, further re-excision may be necessary despite an initial, presumably adequate, WLE. In this study, we analyzed the impact of initial biopsy type (shave, punch, or excision) on the management of melanoma.
Methods: A retrospective chart review of 243 patients with clinically node-negative melanoma was completed. Evaluated variables included the initial biopsy type, initial and final peripheral and deep margin status, further reexcision rates, tumor site, and clinician specialty performing the biopsy. Univariate and multivariate analyses tests were performed using SPSS software.
Results: 29.5% of specimens with both positive peripheral and deep margins underwent further excisions. Overall, 14.6% of cases had re-excision regardless of initial biopsy type after initial WLE. There was higher rate of re-excision with an initial excision biopsy (28.6%) than with initial punch (13.3%) or shave biopsies (11.2%) Dermatologists, Surgeons, and Primary Care Physicians performed 13%, 34%, and 32% of the excision biopsies respectively. Neither the anatomic location of the tumor nor the survival rates were significantly correlated to the biopsy type, margin status, or re-excision rates.
Conclusion: Both shave and punch biopsies showed high rates of residual tumor in either peripheral or deep margins but this does not translate into a higher re-excision rate. Although the biopsy type is important, the clinical specialty performing the biopsy could be influential. Surprisingly, there was a higher positive peripheral margin than deep margin with shave biopsy.PDF
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