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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: [email protected]
61939 : 4 :APRIL 2013
NEMETH-OCHOA