COMMENTARY

Prognosis of Patients with Transected Melanomas

SHARI NEMETH-OCHOA, MD, MS*

The author has no conflicts of interest to disclose.

Several authors have examined the effect of

tumor transection and biopsy type on prelimin-

ary and final Breslow depth and staging in patients

with melanoma. This interest in tumor transection

stems in part from the debate surrounding the

validity of different biopsy types for pigmented

lesions, particularly shave biopsies. Previous studies

have shown that there is a risk of underestimating

Breslow depth with shave biopsy but that this

changes management in only a small percentage of

patients.1 These authors did not examine long-term

outcomes in patients whose Breslow depth or

management changed because of tumor transection

on initial biopsy.

In this study by Martires and colleagues, 23% of

melanomas were transected on initial biopsy.2

Transection did not affect overall survival or

portend a poorer outcome in those patients

when controlling for other risk factors including

Breslow depth. Another recent study showed

that transection on initial biopsy does not affect

overall disease-free survival or mortality and

that shave biopsies are 99% accurate for tumor

staging.3

The evidence provided here supports the use of

shave biopsy for most pigmented lesions without

significant adverse outcomes associated with the

possibility of tumor transection. In an era in which

evidence-based medicine and cost-containment

direct the formation of practice guidelines, these

authors have shown that the biopsy option with

minimal set-up and equipment cost (shave biopsy)

does not adversely affect patient outcomes.

Because there are still likely to be those who are

skeptical about the role of shave biopsy in pig-

mented lesions, perhaps new advances in imaging

technology will put this discussion to rest in the

future. The increasing use of dermoscopy by clini-

cians may result in fewer transected melanomas.

Dermoscopic findings raise our index of suspicion

for melanoma, possibly resulting in deeper saucer-

izations or excisional biopsies at initial presentation.

Newer minimally invasive imaging modalities, such

as confocal microscopy, may eventually allow us to

assess both peripheral margins and Breslow depth.

Then we may be able to accurately triage patients for

treatment or additional studies looking for

metastatic disease before any biopsy at all.

*Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA

© 2013 by the American Society for Dermatologic Surgery, Inc. � Published by Wiley Periodicals, Inc. �ISSN: 1076-0512 � Dermatol Surg 2013;39:618–619 � DOI: 10.1111/dsu.12139

618

References

1. Moore P, Hundley J, Hundley J, Levine EA, et al. Does shave

biopsy accurately predict the final Breslow depth of primary

cutaneous melanoma? Am Surg 2009;75:369–73.

2. Martires K, Nandi T, Honda K, Cooper J, Bordeaux J. Prognosis

of patients with transected melanomas. Dermatol Surg 2013;39:

605–15.

3. Mir M, Chan CS, Khan F, et al. The rate of melanoma transection

with various biopsy techniques and the influence of tumor

transection on patient survival. J Am Acad Dermatol 2012; Sept 8.

[Epub ahead of print]

Address correspondence and reprint requests to: ShariNemeth-Ochoa, MD, MS, Department of Dermatology,13400 East Shea Blvd Scottsdale, AZ 85259, USA, ore-mail: ochoa.shari@mayo.edu

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