Elsevier

Clinics in Dermatology

Volume 28, Issue 3, May–June 2010, Pages 316-318
Clinics in Dermatology

Incisional biopsy and melanoma prognosis: Facts and controversies

https://doi.org/10.1016/j.clindermatol.2009.06.013Get rights and content

Abstract

Facing the increasing number of melanoma patients is the controversial question of whether an incisional biopsy is associated with an unfavorable patient prognosis. Results of nine studies that occurred during the last four decades were reviewed. One of these studies was a large, prospective randomized controlled trial. Evidence from this trial and from most other studies is that incisional biopsies were not associated with an unfavorable prognosis for melanoma patients. Incisional biopsies are currently recommended for the histopathologic diagnosis of large tumors in facial, mucosal, and acral locations. Complete excisional biopsies are the generally recommended standard for melanoma surgery. Incisional biopsies of malignant melanoma do not negatively influence prognosis. Complete excision of primary melanoma is still the recommended standard of care and is a precondition for accurate histopathologic diagnosis.

Introduction

Melanoma incidence is increasing worldwide in the last decades, but the mean tumor thickness is decreasing.1 It involves an increasing number of excisions of thin melanomas and simultaneously a high number of dysplastic nevi and other pigmented lesions suspicious of melanoma. This raises the question of whether time-consuming total excisions could be replaced in some cases by incisional biopsies, which are easier to handle and more cost-effective. A disadvantage of incisional biopsies is a less reliable histopathologic diagnosis,2 but another question is still of concern to physicians as well as patients and is still discussed worldwide: Will cutting into the tumor cause harm?

Section snippets

Type of biopsy and prognosis of melanoma

Whether cutting into a tumor leads to an inferior prognosis for the patient has been debated for decades. A noli me tangere (“do not touch me”) strategy is still often considered as appropriate. Complete excisions are performed to obtain a better histologic result and are still preferred by some surgeons to avoid displacing tumor cells and possibly causing tumor seeding. There is still concern that incomplete excisions or punch biopsies will harm patients, although several recent studies showed

Discussion

Most retrospective and prospective studies did not show an influence on patient outcome after incisional or excisional biopsies. Limitations of the older studies were small numbers of patients and lack of control of well-established prognostic factors such as tumor thickness, ulceration, localization, and age. Because recent large studies have not shown any significant difference in prognosis after different types of biopsies, there is currently no evidence that incisional biopsies could alter

Conclusions

Incisional biopsies or incomplete primary excisions do not seem to influence patient prognosis in any way. Nevertheless, a complete primary excision of suspicious lesions should generally be performed to conserve the total architecture of the lesion whenever it is possible. This is a precondition to achieve an accurate histopathologic diagnosis comprising a proper evaluation of tumor thickness and ulceration.

Some basic indications have been established for incisional biopsies of suspicious

References (17)

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