Abstract: Melanoma Incidence in Shaved Pigmented Lesions (Plastic Surgery 2013)

Saturday, October 12, 2013: 2:55 PM

Mitchell Duncan Flurry, MD , Plastic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA

Bryan Anderson, MD , Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA

Loren E. Clarke, MD , Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA

Joseph Drabick , Division of Hematology/Oncology, Penn State Milton S. Hershey Medical Center, Hershey, PA

Donald R. Mackay, MD , Division of Plastic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA

Rogerio I. Neves, MD, PhD , Penn State Milton S Hershey Med Cnt, Hershey, PA

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Introduction:

The debate over proper biopsy technique for pigmented lesions is on-going. Previous surgical literature warns against the use of shave biopsy to prevent sampling error. Current NCCN guidelines state excisional biopsy is preferred, but allow for shave biopsy when the index of suspicion is low. Although controversial, shave biopsy is frequently performed on pigmented lesions. This study's goal is to assess the incidence of melanoma for all shave biopsies and its impact in appropriate treatment for the patient.

Methods:

A retrospective chart review was performed on all patients who had a shave biopsy performed by the Dermatology Department for the diagnosis of a pigmented lesion from 2009 to 2010. Using an institutional database, a natural language search was conducted. The Pre-biopsy Diagnosis, Final Diagnosis and any Comments were recorded.

Results:

1827 shave biopsies of pigmented lesions were performed during the 24-month study period. 138 (7.6%) of the shaved specimens were Melanoma. Of the 138 melanomas shaved, 62 % had a positive margin and 16% had a positive deep margin. Out of the 1827 biopsies, 25 (1.4%) required an “Upstage” or a change in treatment due to inadequacy of the biopsy.

Discussion:

Tumor thickness is the most important histologic factor in determining prognosis and treatment of melanoma. Shave biopsies can be unreliable at determining the full depth of a tumor. The possible consequences are twofold: an “upstage” in treatment and exclusion from clinical trials. These and other reasons are the arguments against use of shave biopsy. However, more recent studies¹ have challenged the surgical dogma that shave biopsy should not be used for the diagnosis of melanoma. These studies have found no change in long-term survival when comparing shave to excisional biopsy. Some important critiques of this study include: all biopsies were performed by Dermatologists trained to recognize melanoma, and they used a “scoop” or deep shaving technique. Also, this study did not include other medical providers who in previous studies have been show to have significantly worse capability of diagnosis melanoma.

Conclusion:

The incidence of melanoma and the incidence of upstage in treatment in this patient population was low. This data, in combination with existing surgical literature indicates that in the right hands the use of shave biopsy in pigmented lesions is safe.

22773 Melanoma Incidence in Shaved Pigmented Lesions