title: Shave biopsy is a safe and accurate method for the initial evaluation of melanoma.
abstract: BACKGROUND
  Shave biopsy of cutaneous lesions is simple, efficient, and commonly used clinically. However, this technique has been criticized for its potential to hamper accurate diagnosis and microstaging of melanoma, thereby complicating treatment decision-making.
  
  
  METHODS
  We retrospectively analyzed a consecutive series of patients referred to the University of Florida Shands Cancer Center or to the Moffitt Cancer Center for treatment of primary cutaneous melanoma, initially diagnosed on shave biopsy to have Breslow depth < 2 mm, to determine the accuracy of shave biopsy in T-staging and the potential impact on definitive surgical treatment and outcomes.
  
  
  RESULTS
  Six hundred patients undergoing shave biopsy were diagnosed with melanoma from extremity (42%), trunk (37%), and head or neck (21%). Mean (± SEM) Breslow thickness was 0.73 ± 0.02 mm; 6.2% of lesions were ulcerated. At the time of wide excision, residual melanoma was found in 133 (22%), resulting in T-stage upstaging for 18 patients (3%). Recommendations for additional wide excision or sentinel lymph node biopsy changed in 12 of 600 (2%) and 8 of 600 patients (1.3%), respectively. Locoregional recurrence occurred in 10 (1.7%) patients and distant recurrence in 4 (0.7%) patients.
  
  
  CONCLUSIONS
  These data challenge the surgical dogma that full-thickness excisional biopsy of suspicious cutaneous lesions is the only method that can lead to accurate diagnosis. Data obtained on shave biopsy of melanoma are reliable and accurate in the overwhelming majority of cases (97%). The use of shave biopsy does not complicate or compromise management of the overwhelming majority of patients with malignant melanoma.
authors.affiliation: Department of Cutaneous Oncology, Moffitt Cancer Center, and the University of South Florida College of Medicine, Tampa, FL 33612, USA. jonathan.zager@moffitt.org
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Suroosh S
authors.initials: SS
authors.lastname: Marzban
authors.forename: Rony
authors.initials: R
authors.lastname: Francois
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Law
authors.forename: Ashley H
authors.initials: AH
authors.lastname: Davis
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.forename: Vladimir
authors.initials: V
authors.lastname: Vincek
authors.forename: Christina
authors.initials: C
authors.lastname: Mitchell
authors.forename: Ann
authors.initials: A
authors.lastname: Church
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult