title: Microstaging accuracy after subtotal incisional biopsy of cutaneous melanoma.
abstract: BACKGROUND
  A significant portion of cutaneous melanoma may remain after subtotal incisional biopsy. The accuracy of microstaging and impact on clinical practice in this scenario are unknown.
  
  
  OBJECTIVE
  Our purpose was to examine microstaging accuracy of an initial incisional biopsy with a significant portion of the clinical lesion remaining (> or =50%).
  
  
  METHODS
  Patients with cutaneous melanoma, diagnosed by incisional biopsy with > or =50% of the lesion remaining, were prospectively evaluated for microstaging accuracy, comparing initial Breslow depth (BD1) to final depth (BD2) after excision of the residual lesion. Impact on prognosis and treatment was also evaluated.
  
  
  RESULTS
  Two hundred fifty of 1783 patients (14%) presented with > or =50% residual clinical lesion after incisional biopsy. The mean BD1 was 0.66 mm; the mean BD2, 1.07 mm (P = .001). After complete excision of the residual lesion, upstaging occurred in 21% and 10% became candidates for sentinel node biopsy.
  
  
  CONCLUSIONS
  An incisional biopsy with > or =50% clinical lesion remaining afterward may be inadequate for accurate microstaging of melanoma. This scenario is relatively uncommon but clinically significant.
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: Darius J
authors.initials: DJ
authors.lastname: Karimipour
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Schwartz
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Wang
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Bichakjian
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Orringer
authors.forename: Anya L
authors.initials: AL
authors.lastname: King
authors.forename: Conway C
authors.initials: CC
authors.lastname: Huang
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology