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Shave Biopsy Negatively Affects Melanoma Treatment Decision Making: Presented at SSO
By Crystal Phend
SAN DIEGO, C.A. -- March 27, 2006 -- Although shave biopsies are often used in an attempt to remove the entire melanoma, excisional biopsy should be the preferred biopsy method, researchers said here at the annual meeting of the Society of Surgical Oncology (SSO).
"The standard should be excisional biopsy," said presenting author Richard L. White, Jr., MD, chief of the division of surgical oncology, Carolinas Medical Center, Charlotte, North Carolina, United States. "If you are going to do a shave biopsy, you need to make it a much thicker biopsy."
Dr. White and colleagues reviewed 223 cases of primary melanoma with known method of biopsy. Margins from the biopsies were either indicated on the pathology report or reviewed from specimen slides.
Fifty-one of the patients had excisional biopsy while 44 had a punch biopsy and 128 had a shave biopsy.
Although shave biopsy was by far the most common method, it also had the highest percentage of deep (more than 1 mm) positive margins at 22%, and a high percentage of positive margins overall at 50%.
"The presence of positive margins and in particular the presence of deep positive margins, in such a large percentage of the shave biopsy specimens compromises the ability of this technique to properly stage patients," Dr. White said. This could compromise appropriate treatment recommendations as well, he added.
Comparatively, excisional biopsy had the lowest number of positive margins (16%) and no deep positive margins. Punch biopsy also had no deep positive margins but had the highest rate of positive margins (68%).
"The presence of tumor at the margin of punch biopsies is an expected result, since this method is often used to diagnose lesions with a large diameter," Dr. White explained.
Mean biopsy thickness was 3.19 mm for excisional biopsy, 3.58 mm for punch biopsy, and 1.41 mm for shave biopsy. The differences between methods were significant as were those between punch and shave biopsy.
Dr. White added that the average depth for shave biopsy was "much, much too thin."
[Presentation title: Method of Biopsy and Incidence of Positive Margins in Primary Melanoma. Poster 83]
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