Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;211(5):213-218.
doi: 10.5694/mja2.50289. Epub 2019 Jul 22.

The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

Sara L de Menezes  1   2 , John W Kelly  1   2 , Rory Wolfe  2 , Helen Farrugia  3 , Victoria J Mar  1   4
Affiliations

The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

Sara L de Menezes et al. Med J Aust. 2019 Sep.

Abstract

Objective: To assess changes in the choice of skin biopsy technique for assessing invasive melanoma in Victoria, and to examine the impact of partial biopsy technique on the accuracy of tumour microstaging.

Design: Retrospective cross-sectional review of Victorian Cancer Registry data on invasive melanoma histologically diagnosed in Victoria during 2005, 2010, and 2015.

Setting, participants: 400 patients randomly selected from each of the three years, stratified by final tumour thickness: 200 patients with thin melanoma (< 1.0 mm), 100 each with intermediate (1.0-4.0 mm) and thick melanoma (> 4.0 mm).

Main outcome measures: Partial and excisional biopsies, as proportions of all skin biopsies; rates of tumour base transection and T-upstaging, and mean tumour thickness underestimation following partial biopsy.

Results: 833 excisional and 337 partial diagnostic biopsies were undertaken. The proportion of partial biopsies increased from 20% of patients in 2005 to 36% in 2015 (P < 0.001); the proportion of shave biopsies increased from 9% in 2005 to 20% in 2015 (P < 0.001), with increasing rates among dermatologists and general practitioners. Ninety-four of 175 shave biopsies (54%) transected the tumour base; wide local excision subsequently identified residual melanoma in 65 of these cases (69%). Twenty-one tumours diagnosed by shave biopsy (12%) were T-upstaged. With base-transected shave biopsies, tumour thickness was underestimated by a mean 2.36 mm for thick, 0.48 mm for intermediate, and 0.07 mm for thin melanomas.

Conclusion: Partial biopsy, particularly shave biopsy, was increasingly used for diagnosing invasive melanoma between 2005 and 2015. Shave biopsy has a high rate of base transection, reducing the accuracy of tumour staging, which is crucial for planning appropriate therapy, including definitive surgery and adjuvant therapy.

Keywords: Biopsy; Cytopathology; Diagnostic tests and procedures; Guidelines as topic; Immunotherapies; Melanoma; Pathology.

PubMed Disclaimer

Comment in

References

    1. Ng JC, Swain S, Dowling JP, et al. The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol 2010; 146: 234-239.
    1. Cancer Council Australia; Melanoma Guidelines Working Party. Clinical practice guidelines for the diagnosis and management of melanoma. Updated Apr 2018. https://wiki.cancer.org.au/australia/Guidelines:Melanoma (viewed May 2019).
    1. Swetter SM, Tsao H, Bichakjian CK, et al. American Academy of Dermatology. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2019; 80: 208-250.
    1. National Institute for Health and Care Excellence. Melanoma: assessment and management [NICE guideline NG14]. July 2015; update 23 May 2019. https://www.nice.org.uk/guidance/ng14/evidence (viewed June 2019).
    1. Kelly JW, Henderson MA, Thursfield VJ, et al. The management of primary cutaneous melanoma in Victoria in 1996 and 2000. Med J Aust 2007; 187: 511-514. https://www.mja.com.au/journal/2007/187/9/management-primary-cutaneous-m....

LinkOut - more resources