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Meta-Analysis
. 2021 Oct;28(11):6168-6176.
doi: 10.1245/s10434-021-09866-3. Epub 2021 Mar 29.

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

Omid Ahmadi  1 , Moushumi Das  2 , Behzad Hajarizadeh  3 , Jon A Mathy  4   5
Affiliations
Meta-Analysis

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

Omid Ahmadi et al. Ann Surg Oncol. 2021 Oct.

Abstract

Background: Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous melanomas are diagnosed by shave biopsy. A systematic review was undertaken to investigate the impact of shave biopsy on tumor staging, treatment recommendations, and prognosis.

Methodology: The MEDLINE, Embase, and Cochrane Library databases were searched for relevant articles. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies.

Results: Fourteen articles from 2010 to 2020 were included. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed a positive deep margin in 42.9% of shave biopsies. Following WLE, change in tumor stage was reported in 7.7% of patients. Additional treatment was recommended for 2.3% of patients in the form of either further WLE and/or sentinel lymph node biopsy. There was high heterogeneity across studies in all outcomes. Four studies reported survival, while no studies found any significant difference in disease-free or overall survival between shave biopsy and other biopsy modalities.

Conclusions: Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin; however, this translated into a change in tumor stage or treatment recommendations in relatively few patients (7.7% and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed.

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Conflict of interest statement

Omid Ahmadi, Moushumi Das, Behzad Hajarizadeh, and Jon A. Mathy have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the review process
Fig. 2.
Fig. 2.
Forest plot of the estimated proportion of deep margin positivity following shave biopsy of melanoma. ES effect size, CI confidence interval. *data on deep margin positivity following shave biopsy was reported for 217 of the cases
Fig. 3.
Fig. 3.
Forest plot of the estimated proportion of change in T stage following WLE of melanoma diagnosed on shave biopsy. ES effect size, CI confidence interval, WLE wide local excision
Fig. 4.
Fig. 4.
Forest plot of the estimated proportion of change in treatment recommendation following WLE of melanoma diagnosed on shave biopsy. ES effect size, CI confidence interval, WLE wide local excision
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