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American Journal of Surgery May 2013Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of...
BACKGROUND
Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of choice for evaluating lesions suspected of being primary melanomas, other biopsy types are commonly used. We sought to determine the impact of biopsy type (excisional, shave, or punch) on outcomes in melanoma.
METHODS
A prospectively collected, institutional review board-approved database of primary clinically node-negative melanomas (stages cT1-4N0) was reviewed to determine the impact of biopsy type on T-staging accuracy, wide local excision (WLE) area (cm(2)), sentinel lymph node biopsy (SLNB) identification rates and results, tumor recurrence, and patient survival.
RESULTS
Seven hundred nine patients were diagnosed by punch biopsy (23%), shave biopsy (34%), and excisional biopsy (43%). Shave biopsy results showed significantly more positive deep margins (P < .001). Both shave and punch biopsy results showed more positive peripheral margins (P < .001) and a higher risk of finding residual tumor (with resulting tumor upstaging) in the WLE (P < .001), compared with excisional biopsy. Punch biopsy resulted in a larger mean WLE area compared with shave and excisional biopsies (P = .030), and this result was sustained on multivariate analysis. SLNB accuracy was 98.5% and was not affected by biopsy type. Similarly, biopsy type did not confer survival advantage or impact tumor recurrence; the finding of residual tumor in the WLE impacted survival on univariate but not multivariate analysis.
CONCLUSIONS
Both shave and punch biopsies demonstrated a significant risk of finding residual tumor in the WLE, with pathologic upstaging of the WLE. Punch biopsy also led to a larger mean WLE area compared with other biopsy types. However, biopsy type did not impact SLNB accuracy or results, tumor recurrence, or disease-specific survival (DSS). Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of melanoma.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Dermatologic Surgical Procedures; Female; Follow-Up Studies; Humans; Linear Models; Male; Melanoma; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Neoplasm Staging; Sentinel Lymph Node Biopsy; Skin Neoplasms; Survival Analysis; Treatment Outcome; Young Adult
PubMed: 23592167
DOI: 10.1016/j.amjsurg.2013.01.023 -
The British Journal of Dermatology Sep 2015
Comparative Study
Topics: Biopsy; Diagnosis, Differential; Dysplastic Nevus Syndrome; Humans; Melanoma; Pigmentation Disorders; Retrospective Studies; Skin; Skin Neoplasms
PubMed: 25864555
DOI: 10.1111/bjd.13830 -
Journal of General Internal Medicine Jan 1998To review three commonly performed skin biopsy procedures: shave, punch, and excision. (Review)
Review
OBJECTIVE
To review three commonly performed skin biopsy procedures: shave, punch, and excision.
DATA SOURCES
English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references.
STUDY SELECTION
Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care.
DATA EXTRACTION
Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques.
DATA SYNTHESIS
Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis.
CONCLUSIONS
Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.
Topics: Biopsy; Humans; Internal Medicine; Physicians, Family; Practice Patterns, Physicians'; Retrospective Studies; Safety; Skin
PubMed: 9462495
DOI: 10.1046/j.1525-1497.1998.00009.x -
Dermatologic Surgery : Official... Apr 1995Several years ago, the razor blade was introduced as an alternative device for performing the shave removal and/or biopsy of skin lesions. Though inexpensive and readily...
BACKGROUND
Several years ago, the razor blade was introduced as an alternative device for performing the shave removal and/or biopsy of skin lesions. Though inexpensive and readily available, the razor blade is somewhat cumbersome to use and poses a risk for accidental injury to the practitioner.
OBJECTIVE
We describe a modification of the razor blade shave biopsy procedure utilizing an innovative adaptor design.
METHODS
A comparison of the adaptor-designed shave biopsy instrument to the standard razor blade device is made.
RESULTS
The modifications implemented in the adaptor design serve to enhance the comfort of performing biopsies, minimize accidental injury, help save time, and provide for a more professional appearing way in which to obtain skin specimens.
CONCLUSION
The new adaptor design helps to facilitate the safe and effective use of the razor blade in dermatologic practice.
Topics: Biopsy; Humans; Skin
PubMed: 7728489
DOI: 10.1111/j.1524-4725.1995.tb00188.x -
Journal of the American Academy of... Nov 2008The biopsy lies at the heart of the management of the suspected melanocytic neoplasm. Dermatologists are the ideal physicians to examine patients with suspect... (Review)
Review
The biopsy lies at the heart of the management of the suspected melanocytic neoplasm. Dermatologists are the ideal physicians to examine patients with suspect melanocytic lesions and an understanding of when and how to perform a biopsy is vital. Various algorithms have been formulated to allow for facilitation of the clinical examination, including the ABCDE rule, the Glasgow 7-point checklist, and the "ugly duckling" sign. Along with this, dermoscopy can increase the sensitivity of diagnosis. Proper training regarding dermatoscopy is essential, especially with algorithms such as the Menzies method, the 7-point checklist, and pattern analysis. Digital photography and digital dermatoscopy allows for surveillance of suspect nevi or patients with multiple nevi. For neoplasms suspected of being melanoma, an excision for diagnosis with 1- to 3-mm borders is ideal, although a shave, punch, or other incisional biopsy can be performed in special circumstances. Finally, research has allowed for promising technologies including gene profiling of tape-stripped samples along with automated software analysis of digital dermatoscopic images.
Topics: Algorithms; Biopsy; Dermoscopy; Humans; Melanoma; Nail Diseases; Nevus, Pigmented; Palpation; Physical Examination; Sensitivity and Specificity; Skin Neoplasms
PubMed: 18762353
DOI: 10.1016/j.jaad.2008.05.027 -
Journal of the American Academy of... May 2018
Topics: Academic Medical Centers; Aged; Aged, 80 and over; Arizona; Biopsy; Cohort Studies; Curettage; Databases, Factual; Dermatology; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Melanoma; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Retrospective Studies; Risk Assessment; Skin Neoplasms
PubMed: 29277732
DOI: 10.1016/j.jaad.2017.12.043 -
Dermatologic Surgery : Official... Oct 2014Concern over transection of melanomas has inhibited many practitioners from using the scoop-shave for removal of pigmented lesions.
BACKGROUND
Concern over transection of melanomas has inhibited many practitioners from using the scoop-shave for removal of pigmented lesions.
OBJECTIVE
To assess the safety and efficacy of the scoop-shave for pigmented lesions.
MATERIALS AND METHODS
The practitioner's clinical diagnosis, intent (sample or completely remove), and removal technique (excision, punch, shave biopsy, or scoop-shave) were recorded. Pathology results including the status of the peripheral and deep margins were subsequently documented.
RESULTS
Over an 8-month period, 333 procedures were performed. Of the 11 melanomas (6 in situ and 5 invasive) removed by the scoop-shave, none had positive deep margins and 6 (2 in situ and 4 invasive) were completely removed. One of the 50 dysplastic nevi removed by scoop-shave had a positive deep margin (moderately dysplastic). Forty-six dysplastic nevi were completely removed by the scoop-shave. When the practitioner's intent was "complete removal," the lesion was completely removed 73.1% of the time by scoop-shave, 91% by standard excision, 18.1% by shave biopsy, and 78.6% by punch excision (p < .0001).
CONCLUSION
The scoop-shave is a safe and effective technique for diagnosis and treatment of melanocytic lesions.
Topics: Biopsy; Humans; Melanoma; Nevus, Pigmented; Prospective Studies; Skin Neoplasms
PubMed: 25229784
DOI: 10.1097/01.DSS.0000452659.60130.68 -
International Journal of Surgical... 2013While excisional biopsy is recommended to diagnose cutaneous melanoma, various biopsy techniques are used in practice. We undertook this study to identify how frequently...
BACKGROUND AND OBJECTIVES
While excisional biopsy is recommended to diagnose cutaneous melanoma, various biopsy techniques are used in practice. We undertook this study to identify how frequently final tumor stage and treatment recommendations changed from diagnostic biopsy to final histopathology after wide local excision (WLE).
METHODS
We compared the histopathology of the dermatopathologist-reviewed diagnostic biopsy and final WLE in 332 cutaneous melanoma patients.
RESULTS
Tumor sites were extremity (51%), trunk (33%), and head/neck (16%). Initial biopsy types were excisional (56%), punch (21%), shave (18%), and incisional (5%). Most diagnostic biopsies were margin positive regardless of technique, and 36% of patients had residual melanoma on WLE. T-stage changed in 8% of patients, of whom 59% were diagnosed by punch biopsy, 15% by incisional biopsy, 15% by shave biopsy, and 11% by excisional biopsy (P < 0.0001). Treatment recommendations changed in 6%: 2% after excisional biopsy, 5% after shave biopsy, 18% after punch biopsy, and 18% after incisional biopsy (P < 0.0001).
CONCLUSIONS
Although most biopsy margins were positive, T-stage and treatment changed for only a minority of melanoma patients. Our data provide valuable information to inform patient discussion regarding the likelihood of a change in prognosis and the need for secondary procedures after WLE. These data support the superiority of dermatopathologist-reviewed excisional biopsy when feasible.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Staging; Prognosis; Sensitivity and Specificity; Skin; Skin Neoplasms; Young Adult; Melanoma, Cutaneous Malignant
PubMed: 24102023
DOI: 10.1155/2013/196493 -
Journal of the American Academy of... Nov 2015
Topics: Aged; Aged, 80 and over; Biopsy; Female; Humans; Hypothermia, Induced; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Single-Blind Method; Skin; Skin Diseases
PubMed: 26475540
DOI: 10.1016/j.jaad.2015.08.005 -
ACS Nano Jun 2023Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of...
Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of techniques to determine the changes in adipose tissue (AT) at the molecular level. Extracellular vesicles (EVs) have emerged as a novel and less invasive source of biomarkers for various pathologies. Furthermore, the possibility of enriching cell or tissue-specific EVs from the biofluids based on their unique surface markers has led to classifying these vesicles as "liquid biopsies", offering valuable molecular information on hard-to-access tissues. Here, we isolated small EVs from AT (sEV) of lean and diet-induced obese (DIO) mice, identified unique surface proteins on sEV by surface shaving followed by mass spectrometry, and developed a signature of five unique proteins. Using this signature, we pulled out sEV from the blood of mice and validated the specificity of isolated sEV by measuring the expression of adiponectin, 38 adipokines on an array, and several adipose tissue-related miRNAs. Furthermore, we provided evidence of sEV applicability in disease prediction by characterizing sEV from the blood of lean and DIO mice. Interestingly, sEV cargo showed a stronger pro-inflammatory effect on THP1 monocytes compared to sEV and a significant increase in obesity-associated miRNA expression. Equally important, sEV cargo revealed an obesity-associated aberrant amino acid metabolism that was subsequently validated in the corresponding AT. Lastly, we show a significant increase in inflammation-related molecules in sEV isolated from the blood of nondiabetic obese (>30 kg/m) individuals. Overall, the present study offers a less-invasive approach to characterize AT.
Topics: Adipose Tissue; Liquid Biopsy; Extracellular Vesicles; Obesity; Humans; Animals; Mice; Biomarkers
PubMed: 37224410
DOI: 10.1021/acsnano.3c00422