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American Journal of Surgery Dec 2005In the era of sentinel lymph node (SLN) biopsy, there has been concern that manipulation, injection, and massage of intact primary melanomas (after incisional or shave... (Comparative Study)
Comparative Study
BACKGROUND
In the era of sentinel lymph node (SLN) biopsy, there has been concern that manipulation, injection, and massage of intact primary melanomas (after incisional or shave biopsy) could lead to an artifactual increased rate of SLN micrometastases or an actual increased risk of recurrence. The aim of this study was to evaluate the difference in the incidence of SLN metastasis, locoregional recurrence (LRR), disease-free survival (DFS), distant disease-free survival (DDFS), or overall survival (OS) for patients who undergo excisional versus incisional versus shave biopsy.
METHODS
Analysis of database from a multicenter prospective randomized study from centers across the United States and Canada. Eligible patients were 18 to 71 years old, with cutaneous melanoma > or = 1.0 mm Breslow thickness. All patients underwent SLN biopsy using blue dye and radioactive colloid injection. SLNd were evaluated by serial histological sections with S100 immunohistochemistry. Statistical analysis was performed using univariate and multivariate analyses with a significance level of P < .05; survival analysis was performed by the Kaplan-Meier method with the log-rank test.
RESULTS
A total of 2,164 patients were evaluated; 382 patients were excluded for lack of biopsy information. Positive SLNs were found in 220 of 1,130 (19.5%), 58 of 281 (20.6%), and 67 of 354 (18.9%) of patients with excisional, incisional, or shave biopsy, respectively (no significant difference). There were significant differences among the 3 biopsy types in ulceration (P = .018, chi2) and regression (P = .022, chi2); there were no differences in age, gender, Breslow thickness, Clark level, lymphovascular invasion, tumor location, or histologic subtype. Biopsy type did not significantly affect LRR, DFS, DDFS, or OS.
CONCLUSIONS
The concern that incomplete excision of primary melanomas may result in an increased incidence of SLN micrometastases, artifactual or real, is unfounded. Similarly, there is no evidence that biopsy type adversely affects locoregional or distant recurrence. Although shave biopsy is generally discouraged because it may lead to inaccurate tumor thickness measurements, it does not appear to affect overall patient outcome.
Topics: Adolescent; Adult; Aged; Disease-Free Survival; Female; Follow-Up Studies; Humans; Incidence; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Multicenter Studies as Topic; Neoplasm Recurrence, Local; Neoplasm Seeding; Prospective Studies; Randomized Controlled Trials as Topic; Sentinel Lymph Node Biopsy; Skin Neoplasms
PubMed: 16307945
DOI: 10.1016/j.amjsurg.2005.08.020 -
Journal of the European Academy of... Mar 2010Monitoring of treatment efficacy after shave biopsy of actinic keratoses (AK) is often difficult, as clinical and dermoscopic features may not be reliable. (Comparative Study)
Comparative Study
BACKGROUND
Monitoring of treatment efficacy after shave biopsy of actinic keratoses (AK) is often difficult, as clinical and dermoscopic features may not be reliable.
OBJECTIVES
We investigated the applicability of in-vivo reflectance confocal microscopy (RCM) for the follow-up of AK after shave biopsy.
METHODS
A total of 10 lesions were investigated by RCM before shave biopsy, after 3 and 12 months by two observers in agreement blinded to location, patients and time interval.
RESULTS
At baseline all lesions showed typical clinical, dermoscopic and RCM criteria of AK. Three months after shave biopsy, all lesions presented clinically as normal skin (NS), but two lesions showed features suspicious for AK by RCM. After 12 months, one lesion of these two lesions changed into NS in RCM, whereas the other lesion progressed into clinical visible AK. At baseline, the two observers diagnosed 10 of 10 lesions correctly in RCM, after 3 months eight of 10 lesions and after 12 months all lesions were diagnosed correctly.
CONCLUSIONS
Our results suggest that RCM might be a useful tool in the follow-up of AK after shave biopsy and might be used in inconclusive clinical and dermoscopic presentations of lesions after surgery or other treatment modalities.
Topics: Aged; Aged, 80 and over; Biopsy; Diagnosis, Differential; Disease Progression; Female; Follow-Up Studies; Humans; Keratosis, Actinic; Male; Microscopy, Confocal; Pilot Projects; Prognosis; Reproducibility of Results; Severity of Illness Index; Time Factors
PubMed: 19732253
DOI: 10.1111/j.1468-3083.2009.03410.x -
The American Surgeon May 2009Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience...
Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively (P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma (P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.
Topics: Aged; Biopsy; Chi-Square Distribution; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Neoplasm, Residual; Predictive Value of Tests; Registries; Retrospective Studies; Skin Neoplasms
PubMed: 19445285
DOI: No ID Found -
Clinical and Experimental Dermatology Jun 2023Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which...
Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy type is more appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCCs treated with MMS. Of the 208 BCC biopsies, 42 (20.2%) were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs. 1.69 stages with the punch technique (P = 0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The biopsy type of choice is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping.
Topics: Humans; Skin Neoplasms; Mohs Surgery; Retrospective Studies; Neoplasm Recurrence, Local; Carcinoma, Basal Cell; Biopsy
PubMed: 36805631
DOI: 10.1093/ced/llad050 -
Dermatologic Surgery : Official... Mar 2013Nonmelanoma skin cancer is an increasingly common disease that is typically treated surgically. After histopathologic confirmation by biopsy, the carcinoma is typically...
BACKGROUND
Nonmelanoma skin cancer is an increasingly common disease that is typically treated surgically. After histopathologic confirmation by biopsy, the carcinoma is typically removed by excision, but not all excisional specimens contain residual carcinoma.
OBJECTIVES
To define the rate of residual basal and squamous cell carcinomas within excisional specimens after shave biopsy in a general dermatology office.
METHODS
We retrospectively reviewed 439 consecutive cases sent to a single dermatopathology lab from a practitioner's general dermatology office who also performs Mohs micrographic surgery. One hundred cases had a histopathologically proven carcinoma on biopsy with subsequent excision. Histopathologic type, location, age, sex, and time from biopsy to excision were all analyzed for statistical association.
RESULTS
Of 57 cases of basal cell carcinoma, 34 (59.6%) had positive residuals. Of 43 cases of squamous cell carcinoma, 12 (27.9%) had positive residuals. Histologic type was significantly associated (p = .002) with residual carcinoma in excisional specimens, with basal cells 2.13 times as likely to have residual carcinoma present.
CONCLUSION
The rate of residual nonmelanoma carcinoma in excision specimens after shave biopsy was found to be different from previously reported in the literature. These data may have therapeutic ramifications if further substantiated.
Topics: Aged; Biopsy; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Neoplasm, Residual; Retrospective Studies; Skin Neoplasms
PubMed: 23279620
DOI: 10.1111/dsu.12056 -
Plastic and Reconstructive Surgery.... Dec 2020Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures...
UNLABELLED
Proper management of Spitz nevi continues to be debated, with treatment ranging from observation to surgery. To better characterize the outcome of surgical procedures performed for incomplete initial excision or biopsy, we sought to ascertain the histopathological presence of residual Spitz nevi in a set of surgical specimens.
METHODS
We retrospectively reviewed 123 records with histologically-confirmed Spitz nevus. Data concerning treatment, clinical features, histopathological margin involvement, and presence of residual lesion on subsequent procedural specimens were collected.
RESULTS
Fifty-three percent of lesions (n = 65) were initially sampled by shave or punch biopsy, and the remainder (n = 58) were formally excised without initial biopsy. The rates of re-excision for involved margins were: shave biopsy (92.2%), punch biopsy (78.6%), and formal excision (13.8%). In total, 61.0% of patients who underwent an initial procedure of any kind had involved margins, but only half of those re-excised for involved margins (57.6%) had histologically residual lesion on repeated excision. A significantly higher proportion of initial punch biopsies (90.9%) resulted in residual lesion (in secondary excision specimens) when compared with shave biopsy (48.9%) and formal excision (62.5%; < 0.05).
CONCLUSIONS
Findings suggest that clinicians may consider shave biopsy over punch biopsy for diagnosing suspected lesions, when indicated and appropriate. Given the rarity of malignant transformation and the frequency of residual nevus, observation may be reasonable for managing pediatric patients with histologically-confirmed Spitz nevi, who are post initial biopsy or excision despite known histopathological margin involvement.
PubMed: 33425580
DOI: 10.1097/GOX.0000000000003244 -
Skinmed 2011A 56-year-old white man presented with a lesion on the right shoulder. The lesion developed during a short period and recently became irritated with occasional bleeding...
A 56-year-old white man presented with a lesion on the right shoulder. The lesion developed during a short period and recently became irritated with occasional bleeding and mild pruritus. The patient denied pain. Medical history included melanoma, nonmelanoma skin cancer, diabetes mellitus type II, hyperlipidemia, multinodular thyroid goiter, and obesity. Medications and family and social history were noncontributory. Review of systems was negative. Examination revealed a slightly raised, friable yellow-pink waxy plaque located on the right shoulder (Figure 1). There was no evidence of excoriation, secondary infection, drainage, scale, crust, atrophy, lichenification, or telangiectasia. The patient had no mucosal or nail changes and the remainder of his skin examination was normal. A shave biopsy on the right shoulder revealed a nodular deposit of homogenous eosinophilic material associated with extravasated erythrocytes within the dermis. An infiltrate of lymphocytes and plasma cells was associated with the deposits. Immunohistochemical stains revealed positive plasma cells with kappa light chain and negative with lambda light chain. Congo red stain was positive and supported the diagnosis. The findings were consistent with nodular cutaneous amyloidosis (NCA) of the amyloid light-type. Initial work-up included referrals to hematology/oncology and to general surgery. The patient had a complete blood cell count (CBC), complete metabolic profile (CMP), serum protein electrophoresis (S-PEP), urine protein electrophoresis (U-PEP), 24-hour urine creatinine clearance, and protein, serum immunoglobulins and 132 microglobulin. These were all within normal limits. Abdominal/pelvic computed tomography and positron emission tomography scan also were within normal limits. Bone marrow biopsy showed no abnormalities. The patient underwent both an abdominal fat pad biopsy as well as a colonoscopy with rectal biopsy. Both were negative for amyloidosis. Initially, the patient's cutaneous amyloidosis remained localized and mild pruritus was controlled with low potency topical steroids. The patient was closely monitored by hematology/oncology and general surgery on a biannual basis to assess the possibility of progression to systemic amyloidosis. Over the course of the subsequent two years, the patient developed multiple similar lesions across the back, shoulders, and chest, which were biopsied and found to be consistent with NCA. Progression of the cutaneous nodules led to disfiguring, painful, and friable pink to yellow waxy papules coalescing into plaques with obvious hemorrhage diffusely over the trunk (Figure 2). In lieu of the painful and disfiguring progression of disease, the patient desired a more aggressive treatment plan. At present, the treatment option recommended to the patient is carbon dioxide laser ablation. Hematology/oncology recommendation consists of a general systemic amyloid reevaluation annually, including CBC, CMP, S-PEP, U-PEP, 24-hour urine collection with creatinine clearance, and history and physical examination.
Topics: Amyloidosis; Biopsy; Disease Progression; Humans; Lasers, Gas; Male; Middle Aged; Shoulder; Skin Diseases
PubMed: 22165048
DOI: No ID Found -
Annales de Dermatologie Et de... Oct 2014
Topics: Fingers; Humans; Male; Middle Aged; Nail Diseases; Skin Neoplasms; Video Recording
PubMed: 25288069
DOI: 10.1016/j.annder.2014.08.001 -
Journal of Lower Genital Tract Disease Oct 2018Periclitoral masses are uncommon disorders in gynecology often leading to pain and distress. With the popularity of female genital hair grooming and depilation, the... (Review)
Review
Periclitoral masses are uncommon disorders in gynecology often leading to pain and distress. With the popularity of female genital hair grooming and depilation, the vulva has been exposed to new insults including contact dermatitis and folliculitis. The unique anatomy of the protective covering of the clitoral hood may subject hair fragments to trapping, inflammation, irritation, and in some cases abscess formation.
Topics: Adolescent; Adult; Dermatitis, Contact; Female; Folliculitis; Hair Removal; Humans; Middle Aged; Skin; Vulva; Young Adult
PubMed: 30074956
DOI: 10.1097/LGT.0000000000000420 -
Archives of Dermatology Mar 2010To compare partial and excisional biopsy techniques in the accuracy of histopathologic diagnosis and microstaging of cutaneous melanoma. (Comparative Study)
Comparative Study
OBJECTIVE
To compare partial and excisional biopsy techniques in the accuracy of histopathologic diagnosis and microstaging of cutaneous melanoma.
DESIGN
Prospective case series.
SETTING
Tertiary referral, ambulatory care, institutional practice. Patients Consecutive cases from 1995 to 2006. Interventions Partial and excisional biopsy. Other factors considered were anatomic site, physician type at initial management, hypomelanosis, melanoma subtype, biopsy sample size, multiple biopsies, and tumor thickness.
MAIN OUTCOME MEASURES
Histopathologic diagnosis (false-negative misdiagnosis-overall or with an adverse outcome-and false-positive misdiagnosis) and microstaging accuracy. Odds ratios (ORs) and 95% confidence intervals (CIs) obtained from multinomial logistic regression.
RESULTS
Increased odds of histopathologic misdiagnosis were associated with punch biopsy (OR, 16.6; 95% CI, 10-27) (P < .001) and shave biopsy (OR, 2.6; 95% CI, 1.2-5.7) (P = .02) compared with excisional biopsy. Punch biopsy was associated with increased odds of misdiagnosis with an adverse outcome (OR, 20; 95% CI, 10-41) (P < .001). Other factors associated with increased odds of misdiagnosis included acral lentiginous melanoma (OR, 5.1; 95% CI, 2-13) (P < .001), desmoplastic melanoma (OR, 3.8; 95% CI, 1.1-13.0) (P = .03), and nevoid melanoma (OR, 28.4; 95% CI, 7-115) (P < .001). Punch biopsy (OR, 5.1; 95% CI, 3.4-7.6) (P < .001) and shave biopsy (OR, 2.3; 95% CI, 1.5-3.6) (P < .001) had increased odds of microstaging inaccuracy over excisional biopsy. Tumor thickness was the most important determinant of microstaging inaccuracy when partial biopsy was used (odds of significant microstaging inaccuracy increased 1.8-fold for every 1 mm increase in tumor thickness; 95% CI, 1.4-2.4) (P < .001).
CONCLUSIONS
Among melanoma seen at a tertiary referral center, histopathologic misdiagnosis is more common for melanomas that have been assessed with punch and shave biopsy than with excisional biopsy. Regardless of biopsy method, adverse outcomes due to misdiagnosis may occur. However, such adverse events are more commonly associated with punch biopsy than with shave and excisional biopsy. The use of punch and shave biopsy also leads to increased microstaging inaccuracy.
Topics: Biopsy; Confidence Intervals; Diagnosis, Differential; Diagnostic Errors; Follow-Up Studies; Humans; Melanoma; Neoplasm Staging; Odds Ratio; Prevalence; Prospective Studies; Referral and Consultation; Reproducibility of Results; Skin Neoplasms; Victoria
PubMed: 20231492
DOI: 10.1001/archdermatol.2010.14