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New Melanoma Guidelines Put Emphasis on Biopsy: Presented at NCCN
By Ed Susman
HOLLYWOOD, F.L. -- March 20, 2006 -- Doctors writing new treatment guidelines for melanoma said the first time clinicians look at a suspicious lesion, they should consider the type of biopsy that should be undertaken.
"Any new growth in the skin should be biopsied," said Daniel Coit, MD, co-leader, Melanoma Disease Management Team, Memorial Sloan-Kettering Cancer Center, and associate professor of medicine, Cornell University Medical School, New York, New York, United States.
The pathology report after a case of melanoma is confirmed should provide the surgeon who will be performing the excision with the Breslow thickness, the Clark level, ulceration status, biopsy depths and marginal status, and presence of satellitosis.
Dr. Coit said the key to a successful biopsy and a good cosmetic outcome depends on doing a complete biopsy the first time. And while the guidelines call for wide margins, exactly how wide they should be has been the subject of several clinical trials, with conflicting levels of evidence, he said.
The authors of the NCCN guidelines found a compromise, with a margin width of 2 mm being recommended, depending upon tumor thickness. "Margins may be modified to accommodate individual anatomic or cosmetic considerations," Dr. Coit said, and noted that the guidelines suggest that for in situ melanomas, pathological confirmation of a negative peripheral margin is important.
The preferred biopsy for melanoma biopsy is an excisional procedure with 1-3 mm margins. While the guideline authors encourage sufficient margins, if the excision is too wide, it could impact the ability of the surgeon to perform subsequent lymphatic mapping.
Also acceptable is a full thickness incisional or punch biopsy of the clinically thickest portion of the lesion. The punch biopsy should be used in critical anatomical regions such as palms of the hand or the soles of the feet, the digits, the face, or the ear, or for very large lesions.
A deep shave biopsy is acceptable when, in the clinicians view, the risk of melanoma is low.
The guidelines also emphasize that the biopsy be read by someone familiar with and competent in diagnosing pigmented lesions.
[Presentation title: Update: Melanoma Guidelines.]
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