Incisional biopsy and melanoma prognosis: Facts and controversies
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
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2016, European Journal of CancerCitation Excerpt :In such cases, dermoscopy may help to guide biopsy. Large studies have shown no evidence that incisional biopsies worsen prognosis as compared with immediate complete excisional biopsy [69,70]. The definitive surgical excision should be performed with safety margins preferentially within 4–6 weeks of initial diagnosis.