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The Australasian Journal of Dermatology Aug 2019The recommended method for histopathological diagnosis of cutaneous melanoma is excisional biopsy, although partial biopsies (shave and punch) are often used. Following...
BACKGROUND
The recommended method for histopathological diagnosis of cutaneous melanoma is excisional biopsy, although partial biopsies (shave and punch) are often used. Following a partial biopsy, treatment guidelines recommend a narrow excisional biopsy to plan definitive management. There is limited evidence on the benefits of direct wide local excision (WLE) following diagnostic partial biopsies.
METHODS
Retrospective cohort study of cutaneous melanoma cases, from two tertiary referral centres from January 2013 to December 2015. Demographic and histopathological data, including tumour thickness (T-stage) from initial biopsy and subsequent excisions, were collected. Logistic regression was used to examine histopathological T-staging between biopsy and subsequent excisions (upstaging).
RESULTS
2304 melanomas (2157 patients) were identified; 455 shave, 308 punch, 14 incisional and 1527 excisional biopsies. Out of 1527, 5 (<1%) excisional biopsies were upstaged from original biopsy T-stage to final WLE; compared to 28/455 (6%) for shave, 45/308 (15%) for punch and 2/14 (14%) for incisional biopsies. Histopathology upstaging were increased with punch (OR, 52.1; 95% CI, 20.5-132.4. P < 0.001) and shave biopsy (OR, 20.0; 95% CI, 7.7-52.0. P < 0.001) compared to excisional biopsy. Upstaging rates of 9.4% for desmoplastic (OR, 6.9; 95% CI, 2.4-19.7. P < 0.001) and 21.9% for acral lentiginous (OR, 18.4; 95% CI, 6.9-49.2. P < 0.001) melanomas were elevated compared to 1.4% for superficial spreading melanoma.
CONCLUSIONS
In most cases, partial biopsy (particularly shave biopsy) can provide sufficient information to plan for definitive surgical melanoma management. Punch and incisional biopsies have elevated upstaging rates, a consideration in planning therapy. Partial biopsies of desmoplastic or acral lentiginous melanomas have high rates of upstaging and should have a complete excision prior to definitive treatment.
Topics: Aged; Biopsy; Cohort Studies; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Staging; Retrospective Studies; Skin Neoplasms
PubMed: 30773625
DOI: 10.1111/ajd.13004 -
Cutaneous and Ocular Toxicology 2015Human/animal shaving biology. (Review)
Review
CONTEXT
Human/animal shaving biology.
OBJECTIVE
To assess the effect of shaving on percutaneous penetration and skin function.
METHODS
We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc.
RESULT
Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence.
CONCLUSION
Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.
Topics: Animals; Antiperspirants; Benzenesulfonates; Cell Proliferation; Cosmetics; Hair Removal; Humans; Pharmaceutical Preparations; Rosaniline Dyes; Skin; Skin Absorption; Species Specificity
PubMed: 25363065
DOI: 10.3109/15569527.2014.966109 -
Annals of Plastic Surgery Jun 2015Initial tissue sampling for diagnosis of suspected basal cell carcinoma (BCC) is typically performed using a shave biopsy technique or punch biopsy.
BACKGROUND
Initial tissue sampling for diagnosis of suspected basal cell carcinoma (BCC) is typically performed using a shave biopsy technique or punch biopsy.
METHODS
Our realization of no residual BCC findings after excision in some patients with biopsy-proven BCC diagnosed through a shave biopsy prompted us to conduct a retrospective study of all consecutive patients with 127 BCCs who were treated in our department between 2006 and 2012. All patients with incompletely excised BCCs after shave biopsy diagnosis were operated on by a single surgeon (R.G.), eliminating variables in preoperative evaluation and surgical technique including margin control and reconstructive approach. Patient demographics, initial BCC site, size, subtype, duration between shave biopsy and surgery, size of excision, findings of intraoperative frozen section analysis, type of closure technique, and final pathology reports were analyzed.
RESULTS
There were 108 residual BCCs diagnosed after surgical excision. Most of the108 BCCs were nodular (52) or micronodular (21) subtype. Eighteen BCCs were treated with excision and primary closure. Flap procedure was performed in 64 BCCs after excision. Twenty-six defects after excision were reconstructed using skin grafts. There was no evidence of residual BCC in 15% of BCCs (19 patients) after surgical treatment. In other words, shave biopsy was found to be curative in 15% of BCCs. Seven patients in no residual BCC group received excision and primary closure. Eleven patients underwent flap reconstruction, whereas only 1 patient required skin grafting. Most of the patients in this group had nodular or micronodular type BCC (14/19).
CONCLUSIONS
We were not able to identify any clinically significant predictors of residual versus no residual BCC, at least within the context of the current study. Although most patients diagnosed with BCC had residual tumors for which they received surgical treatment, 15% of patients had to undergo primary closure, skin graft, or flap procedure for negative residual BCC. We would like to promote greater awareness on the subject among plastic surgeons treating BCCs. And, it is extremely important that the informed consent should include statements regarding possible reconstructive procedures even in the case of nonpersistent tumor from medicolegal standpoint.
Topics: Adult; Aged; Biopsy; Carcinoma, Basal Cell; Follow-Up Studies; Humans; Middle Aged; Mohs Surgery; Plastic Surgery Procedures; Retrospective Studies; Skin; Skin Neoplasms; Skin Transplantation; Surgical Flaps; Treatment Outcome
PubMed: 25969972
DOI: 10.1097/01.SAP.0000462324.61391.04 -
Journal of the American Academy of... Jan 2012Basal cell carcinoma (BCC) is a common skin cancer for which the treatment and recurrence risk correlate with the histologic subtype. Limited information is available...
BACKGROUND
Basal cell carcinoma (BCC) is a common skin cancer for which the treatment and recurrence risk correlate with the histologic subtype. Limited information is available regarding the accuracy of biopsy in diagnosing BCC subtypes.
OBJECTIVE
We sought to determine the correlation between BCC subtypes present in a biopsy specimen and the actual subtypes present in a tumor.
METHODS
In this retrospective study, skin biopsy specimens and corresponding excisions were reviewed. All histologic subtypes present in the biopsy specimen were reported and compared with the composite BCC subtype present in the biopsy specimen and excision.
RESULTS
A total of 232 biopsy specimens and corresponding wide excisions were examined. The biopsy specimen accuracy rate was 82% for punch and shave biopsy specimens. Mixed histologic subtypes were seen in 54% of the cases, half of which contained an aggressive subtype (infiltrative, morpheaform, or micronodular). There was an 18% discordance rate between the biopsy specimen subtype and the composite subtype. Importantly, 40% of these discordant cases (7% of all cases examined) had an aggressive subtype that was not sampled in the initial biopsy specimen. Furthermore, some cases were misidentified as infiltrative subtype in the biopsy specimen as a result of misinterpretation of surface ulceration and reactive stromal changes.
LIMITATIONS
The limited number of punch biopsy specimens and the fact that Mohs excisions were not included are limitations.
CONCLUSIONS
Punch and shave biopsy specimens provided adequate sampling for correct BCC subtyping in 82% of the cases examined. However, 18% of the biopsy specimens were misidentified, some of which missed an aggressive component. Thus, there are potential pitfalls in the identification of BCC subtypes in biopsy specimens, which may have important implications in treatment outcome.
Topics: Biopsy; Carcinoma, Basal Cell; Humans; Skin; Skin Neoplasms
PubMed: 21798620
DOI: 10.1016/j.jaad.2011.02.042 -
Dermatologic Surgery : Official... Nov 2015Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation...
BACKGROUND
Cutaneous biopsy sites are often difficult to discern or are frequently misidentified when patients present for the treatment of skin cancers. This frustrating situation can lead to delays in treatment and wrong site surgeries. Current methods aiming to prevent this situation are not perfect.
OBJECTIVE
This study seeks to determine the efficacy of ultraviolet-fluorescent tattoos in facilitating the correct identification of suspected nonmelanoma skin cancer biopsy sites.
METHODS
In this prospective cohort, 51 shave biopsy sites were tattooed with ultraviolet-fluorescent ink in a series of 31 patients suspected of having a cutaneous malignancy. At the time of follow-up, the ability of the patient and the physician to identify the correct site with and without ultraviolet illumination of the tattoo was recorded. Visibility of the tattoo was graded before and after treatment.
RESULTS
Patients could not positively identify their biopsy site in 35% of cases. In 7% of cases, physicians could not confidently identify the site without the aid of ultraviolet illumination. In conjunction with tattoo illumination, physicians confidently identified the site in 100% of the cases. No adverse events occurred.
CONCLUSION
Ultraviolet-fluorescent tattoos offer a safe and reliable means of accurately marking cutaneous biopsy sites.
Topics: Aged; Aged, 80 and over; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Fluorescent Dyes; Humans; Keratosis, Actinic; Male; Middle Aged; Prospective Studies; Skin; Skin Neoplasms; Tattooing; Ultraviolet Rays
PubMed: 26445291
DOI: 10.1097/DSS.0000000000000511 -
Der Hautarzt; Zeitschrift Fur... Jul 2018Compared with adulthood, inflammatory skin diseases are relatively rarely biopsied in children. Apart from the invasiveness of the procedure, the required local... (Review)
Review
Compared with adulthood, inflammatory skin diseases are relatively rarely biopsied in children. Apart from the invasiveness of the procedure, the required local anesthesia, and the risks of infection and scarring, the psychological trauma of the operation has a higher impact in childhood. If a biopsy is performed, expectations towards the dermatopathology report are high. However, the evaluation of biopsies taken from children is challenging for the dermatopathologist: on the one hand, because the biopsies are often tiny or just superficial shaves and, on the other hand, because criteria for evaluation have mostly been developed from findings in adult biopsy specimens. In children, the immune system is still in the process of maturation and, therefore, infiltrates in the skin may look different from those seen in adults; however, knowledge about that is very limited to date. Moreover, numerous rare genodermatoses may manifest themselves first in childhood and need to be considered in the differential diagnosis while experience with them is often limited. Starting from the clinical presentation, this article presents histopathological features of possible differential diagnoses in order to demonstrate the value or necessity of a skin biopsy in a pediatric patient. In addition, communication with parents and child, methods of local anesthesia and biopsy techniques will be considered.
Topics: Adult; Biopsy; Child; Cicatrix; Dermatitis; Diagnosis, Differential; Humans; Skin; Skin Diseases
PubMed: 29869129
DOI: 10.1007/s00105-018-4205-7 -
Dermatology Online Journal Nov 1999Review of filed histopathology material of 525 cases of definite melanomas and other atypical pigmented lesions showed that diagnostic certainty was greatest for...
Review of filed histopathology material of 525 cases of definite melanomas and other atypical pigmented lesions showed that diagnostic certainty was greatest for excisional or deep shave specimens. Shave and particularly punch biopsy specimens were associated with less certainty. The data of this study suggest that punch biopsy should be avoided for pigmented lesions and that a properly done deep shave biopsy is nearly equal to an excision in diagnostic content for such lesions.
Topics: Biopsy; Diagnosis, Differential; Humans; Melanoma; Skin Neoplasms
PubMed: 10673457
DOI: No ID Found -
Dermatologic Surgery : Official... Jun 2003Lidocaine iontophoresis is a method of topical anesthesia in which lidocaine is driven into the skin under the influence of electric current. (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Lidocaine iontophoresis is a method of topical anesthesia in which lidocaine is driven into the skin under the influence of electric current.
OBJECTIVE
To compare lidocaine iontophoresis to placebo for topical anesthesia before shave biopsy in adult patients.
METHODS
This was a single-center, double-blind, placebo-controlled evaluation of iontophoresis of 2% lidocaine with 1:100,000 epinephrine in patients undergoing shave biopsy. Patients were evaluated for sensation to pinprick after iontophoresis. After completion of the procedure, those patients who did not receive supplemental lidocaine rated the pain associated with the procedure using a 10-cm visual analog scale. The investigator also evaluated the patient's pain after biopsy. Treatment sites were examined for evidence of adverse events such as erythema, urticaria, or burns.
RESULTS
Forty-one patients undergoing shave biopsy for evaluation of skin lesions were enrolled. Nineteen of 21 patients in the lidocaine group versus 2 of 20 placebo patients required no supplemental anesthesia (P<0.001). The pain reported by the patient on the visual analog scale subsequent to the procedure was significantly lower in the lidocaine group (P<0.001). In concordance with the results reported by the patients, investigators rated pain lower in the lidocaine group (P<0.001). Blanching and/or erythema occurring at the iontophoresis-treated site in 37 of 41 patients resolved within 1 hour. There were no other treatment-related events.
CONCLUSIONS
Lidocaine iontophoresis is a safe and effective method of administering topical anesthesia before shave biopsy in adult patients.
Topics: Administration, Topical; Adult; Anesthetics, Local; Biopsy; Double-Blind Method; Female; Humans; Iontophoresis; Lidocaine; Male; Middle Aged; Pain; Preoperative Care; Prospective Studies; Skin; Treatment Outcome
PubMed: 12786707
DOI: 10.1046/j.1524-4725.2003.29142.x -
The British Journal of Dermatology Dec 2010Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. Topical application...
BACKGROUND
Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. Topical application of aluminium chloride (AlCl(3)) enhances contrast in RCM images by brightening nuclei.
OBJECTIVES
To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl(3) as a contrast agent.
METHODS
AlCl(3) staining was optimized, in terms of concentration vs. immersion time, on excised tissue ex vivo. RCM imaging protocol was tested in patients undergoing shave biopsies. The RCM images were retrospectively analysed and compared with the corresponding histopathology.
RESULTS
For 35% AlCl(3) , routinely used for haemostasis in clinic, minimum immersion time was determined to be 1 min. We identified three consistent patterns of margins on RCM mosaic images by varying depth: epidermal margins, peripheral dermal margins, and deep dermal margins. Tumour islands of basal cell carcinoma were identified at peripheral or deep dermal margins, correlating on histopathology with aggregates of neoplastic basaloid cells. Atypical cobblestone or honeycomb patterns were identified at the epidermal margins in squamous cell carcinomas, correlating with a proliferation of atypical keratinocytes extending to biopsy margins.
CONCLUSIONS
RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intraoperative mapping in surgical wounds.
Topics: Adult; Aluminum Chloride; Aluminum Compounds; Astringents; Biopsy; Carcinoma, Basal Cell; Chlorides; Feasibility Studies; Female; Humans; Male; Microscopy, Confocal; Retrospective Studies; Skin; Skin Neoplasms
PubMed: 20874785
DOI: 10.1111/j.1365-2133.2010.10063.x -
American Family Physician Jan 2012Cutaneous malignant melanoma accounts for 3 to 5 percent of all skin cancers and is responsible for approximately 75 percent of all deaths from skin cancer. Persons with... (Review)
Review
Cutaneous malignant melanoma accounts for 3 to 5 percent of all skin cancers and is responsible for approximately 75 percent of all deaths from skin cancer. Persons with an increased number of moles, dysplastic (also called atypical) nevi, or a family history of the disease are at increased risk compared with the general population. An important tool to assist in the evaluation of potential melanomas for patients and health care professionals is the ABCDE mnemonic, which takes into account asymmetry, border irregularities, color variation, diameter, and evolution. Any suspicious pigmented lesion should be biopsied. Appropriate methods of biopsy can vary, and include deep shave, punch, and excisional biopsy. Regardless of the procedure selected, it is essential that the size of the specimen be adequate to determine the histologic depth of lesion penetration, which is known as the Breslow depth. The Breslow depth is the most important prognostic parameter in evaluating the primary tumor. Because early detection and treatment can lead to identification of thinner lesions, which may increase survival, it is critical that physicians be comfortable with evaluating suspicious pigmented lesions and providing treatment or referral as necessary.
Topics: Biopsy; Dermoscopy; Humans; Incidence; Melanoma; Neoplasm Staging; Nevus; Practice Guidelines as Topic; Primary Health Care; Skin; Skin Neoplasms; United States
PubMed: 22335216
DOI: No ID Found