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International Journal of Surgical Oncology
Volume 2013, Article ID 196493, 7 pages
Clinical Study

Accuracy of Diagnostic Biopsy for Cutaneous Melanoma: Implications for Surgical Oncologists

1Department of Surgery, NorthShore University HealthSystem, Skokie Hospital, Skokie, IL, USA
2Rush University Medical Center, Chicago, IL, USA
3Rush Medical College, Chicago, IL, USA
4Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

Received 2 June 2013; Accepted 1 August 2013

Academic Editor: Steven N. Hochwald

Copyright © 2013 Tina J. Hieken et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background and Objectives. While excisional biopsy is recommended to diagnose cutaneous melanoma, various biopsy techniques are used in practice. We undertook this study to identify how frequently final tumor stage and treatment recommendations changed from diagnostic biopsy to final histopathology after wide local excision (WLE). Methods. We compared the histopathology of the dermatopathologist-reviewed diagnostic biopsy and final WLE in 332 cutaneous melanoma patients. Results. Tumor sites were extremity (51%), trunk (33%), and head/neck (16%). Initial biopsy types were excisional (56%), punch (21%), shave (18%), and incisional (5%). Most diagnostic biopsies were margin positive regardless of technique, and 36% of patients had residual melanoma on WLE. T-stage changed in 8% of patients, of whom 59% were diagnosed by punch biopsy, 15% by incisional biopsy, 15% by shave biopsy, and 11% by excisional biopsy ( ). Treatment recommendations changed in 6%: 2% after excisional biopsy, 5% after shave biopsy, 18% after punch biopsy, and 18% after incisional biopsy ( ). Conclusions. Although most biopsy margins were positive, T-stage and treatment changed for only a minority of melanoma patients. Our data provide valuable information to inform patient discussion regarding the likelihood of a change in prognosis and the need for secondary procedures after WLE. These data support the superiority of dermatopathologist-reviewed excisional biopsy when feasible.