The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival.

This is interesting. Survival does not change due to biopsy technique (but there does seem to be a trend). But I wonder how many melanoma diagnoses are missed due to sub-optimal biopsy technique?

Ian

 

 

J Am Acad Dermatol. 2012 Sep 8. [Epub ahead of print]

The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival.

Source

Baylor College of Medicine, Houston, Texas.

Abstract

BACKGROUND:

Depth of melanoma invasion is critical because it dictates patient treatment and prognosis. Recent reports indicate melanoma transection with initial biopsy does not impact patient survival; however, tumor transection can lead to misdiagnosis and inaccurate staging.

OBJECTIVE:

This study assessed the rate of melanoma transection with various biopsy techniques and the impact of tumor transection on patient survival.

METHODS:

We conducted a retrospective review of all melanoma cases at our institution between 2000 and 2008. Of the 490 melanoma cases identified, 479 met inclusion criteria for the study. The transection rates of biopsy techniques were determined. Cases of transected tumors were matched with nontransected cases in a retrospective case-control fashion to evaluate survival.

RESULTS:

The rate of melanoma transection was 1.5% for excisional biopsies, 4.1% for punch biopsies, and 9.0% for saucerization biopsies. The means of disease-free survival for the control and transected groups were 911 days and 832.7 days, respectively (P value .67). Overall survival for the control group was 1073.7 days versus 1012.4 days for the transected group (P value .72).

LIMITATIONS:

The study used a select population. The sample size of transected biopsies was limited, in turn limiting the power of the study. Residents performed the majority of biopsies.

CONCLUSION:

Punch and saucerization biopsies were more likely to transect tumors than excisional biopsies. The transection of melanoma did not affect overall disease-free survival or mortality in the population studied.

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  1. #1 by hein2cv on September 18, 2012 - 1:37 am

    Thanks, Ian, interesting. And, as so often, quite counterintuitive, really!

  2. #2 by Tony Dicker on September 18, 2012 - 2:11 am

    Interesting timing. June Robinson was presenting a case in Queenstown on the weekend. The initial punch biopsy was a 1.3mm Melanoma. With the wide excision 2 weeks later, strands of Melanoma had been seeded down the punch biopsy track into the subcutaneous tissue.

    THis made her nervous

  3. #3 by hein2cv on September 18, 2012 - 3:45 am

    Note your comment, Tony – hence the counterintuitivity of these findings. I guess it depends on the timing of recall of biopsied pts, and doing the definitive excision. Laparoscopic intra-abdominal tumour resection suffers from the same anxieties: increased risk of tumour transection, hence increased risk of peritoneal seeding, cfr to open surgery. Also, rupture of extraction bags with e.g. a crushed renal cell carcinoma inside – but that’s bit is getting away from this topic a bit, sorry.

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