title: Clinical impact of biopsy method on the quality of surgical management in melanoma.
abstract: OBJECTIVE
  Though guidelines recommend excisional biopsy for diagnosing melanoma, partial biopsy techniques are commonly performed, risking underestimation of Breslow depth and altering surgical management. Biopsy choice patterns by specialty and subsequent impact on surgical management was examined.
  
  
  METHODS
  Retrospective review of the University of Vermont Cancer Registry. All patients with a single, primary cutaneous melanoma from 1/02 to 6/12 analyzed.
  
  
  RESULTS
  Among 853 lesions analyzed, 606 had Breslow depth <1 mm. Dermatologists perform 62.6% of biopsies, favoring shave biopsies; surgeons favor excisional biopsies (48%), and primary care doctors favor punch biopsies (44.8%), (P < 0.001). Final Breslow depth was upstaged in 107 (12.5%); however, only 23 of 488 partial biopsies (4.7%) displayed a discrepancy great enough to change surgical recommendations (P < 0.001). There was no statistically significant relationship with presence of ulceration, regression, high Clark level, or high mitotic index.
  
  
  CONCLUSIONS
  Partial biopsy techniques are commonly performed in diagnosing melanoma; especially among dermatologists, who perform the majority of biopsies. Though partial biopsies were less accurate in determining Breslow thickness; they rarely alter recommendations for surgical management. Predictive features could not be determined to identify the few cases where a Breslow discrepancy was clinically relevant.
authors.affiliation: Department of Surgery, Danbury Hospital, Danbury, Connecticut.
authors.forename: Sameer
authors.initials: S
authors.lastname: Kaiser
authors.forename: Rashida
authors.initials: R
authors.lastname: Vassell
authors.forename: Richard G
authors.initials: RG
authors.lastname: Pinckney
authors.forename: Todd E
authors.initials: TE
authors.lastname: Holmes
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D058996:Quality Improvement; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: cancer; dermatology; shave; skin; surgery