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Biopsy Accuracy Varies For Invasive Cutaneous Melanoma

Deep shave biopsies are preferable to superficial shave or punch biopsies for thin and intermediate depth melanomas when initial samples are taken for diagnosis instead of complete excision.

Researchers in the United States make this suggestion following a retrospective evaluation of the accuracy of preliminary biopsies of 145 cases of invasive cutaneous melanoma.

Dr P C Ng and colleagues from the Case Western Reserve University/University Hospitals of Cleveland, Ohio, used biopsies done by 72 dermatologists. Forty six of the dermatologists were highly experienced.

An accurate initial biopsy of the deepest portion of a melanoma is vital to the management of patients with these tumours. To determine if initial biopsy was representative of the final depth of the tumour in these cases, these investigators compared Breslow depth on preliminary biopsy with Breslow depth on subsequent excision.

Overall, 88% of non-excisional initial shave and punch biopsies in the 145 study cases were accurate, with Breslow depth greater than or equal to subsequent excision Breslow depth.

Both superficial and deep shave biopsies were more accurate than was punch biopsy for melanomas of less than 1 mm.

Overall, excisional biopsy was found to be the most accurate, these investigators report.
J Am Acad Dermatol 2003 Mar;48:3:420-4. "Evaluating invasive cutaneous melanoma: Is the initial biopsy representative of the final depth?"

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