Oncologic Accuracy of Shave Biopsy for Malignant Melanoma: A Diagnostic Dilemma

Purpose

The diagnosis of melanoma is made by biopsy of skin lesions that is often performed by dermatologists. While surgical dogma favors a punch biopsy that includes the entire depth of the lesion for safe and accurate diagnosis, it is common practice for a shave biopsy to be performed (1). The authors investigate the adequacy of shave biopsy for malignant melanoma.

 

Methods

All consecutive patients who underwent resection of melanoma over a three-year period (Jan 2011 – Jan 2014 ) were included in the study.  Pathology reports from shave biopsy and final surgical resection specimen reports were evaluated. Clinical outcomes were assessed in all patients.

 

Results

Of the 523 patients treated during the study period, 388 had a shave biopsy (74%). There were 99 patients in which the biopsy type was not specified. The remaining 36 patients had either excisional or incisional biopsies performed. Comparison of final pathology results with shave biopsy revealed that 25 out of 388 patients (6.5%) had shave biopsies that underestimated tumor depth.  Accordingly, these patients were upstaged on final pathology. There were positive margins on the surgical specimen in only 1 of 24 patients in which tumor size was upstaged.  

 

Conclusion

Shave biopsy is an oncologically adequate technique for the diagnosis and evaluation of malignant melanoma.