title: Evaluating invasive cutaneous melanoma: is the initial biopsy representative of the final depth?
abstract: BACKGROUND
  An accurate initial biopsy of the deepest portion of the melanoma is vital to the management of patients with melanomas.
  
  
  OBJECTIVE
  Our goal was to evaluate the accuracy of preliminary biopsies performed by a group of predominantly experienced dermatologists (n = 46/72).
  
  
  METHODS
  A total of 145 cases of cutaneous melanoma were examined retrospectively. We compared Breslow depth on preliminary biopsy with Breslow depth on subsequent excision. Was the initial diagnostic biopsy performed on the deepest part of the melanoma?
  
  
  RESULTS
  Of nonexcisional initial shave and punch biopsies, 88% were accurate, with Breslow depth greater than or equal to subsequent excision Breslow depth. Both superficial and deep shave biopsies were more accurate than punch biopsy for melanomas less than 1 mm. Excisional biopsy was found to be the most accurate method of biopsy.
  
  
  CONCLUSIONS
  Deep shave biopsy is preferable to superficial shave or punch biopsy for thin and intermediate depth (<2 mm) melanomas when an initial sample is taken for diagnosis instead of complete excision. We found that a group of predominantly experienced dermatologists accurately assessed the depth of invasive melanoma by use of a variety of initial biopsy types.
authors.affiliation: Department of Dermatology, Case Western Reserve University/University Hospitals of Cleveland, Ohio 44106, USA.
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Ng
authors.forename: David A
authors.initials: DA
authors.lastname: Barzilai
authors.forename: Sahar A
authors.initials: SA
authors.lastname: Ismail
authors.forename: Richard L
authors.initials: RL
authors.lastname: Averitte
authors.forename: Anita C
authors.initials: AC
authors.lastname: Gilliam
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D002983:Clinical Competence; D003880:Dermatology / Q000379:methods; D005194:Family Practice / Q000379:methods; D005260:Female; D013502:General Surgery / Q000379:methods; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*