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Journal of the American Academy of... May 2007Longitudinal melanonychia (LM) may represent nail matrix melanocyte activation (defined as a normal number of melanocytes with increased production of melanin), benign...
Longitudinal melanonychia (LM) may represent nail matrix melanocyte activation (defined as a normal number of melanocytes with increased production of melanin), benign hyperplasia, or melanoma, in addition to multiple nonmelanocyte pathologies, including hemorrhage and infection. This article details an algorithmic approach to LM, including a careful history and physical examination, dermoscopy, and ability to sample the matrix using 3 biopsy techniques, a 3-mm punch excision, a lateral longitudinal excision, and a matrix shave biopsy. Facility with all 3 techniques will allow the physician to procure appropriate nail matrix specimens for diagnosis.
Topics: Algorithms; Biopsy; Humans; Hyperplasia; Melanocytes; Melanoma; Nail Diseases; Nails; Pigmentation Disorders; Skin Neoplasms; Skin Pigmentation
PubMed: 17437887
DOI: 10.1016/j.jaad.2006.12.001 -
Annals of Surgical Oncology Feb 2007The staging of patients with primary melanoma is dependent on adequate sampling of the tumor thickness. Initial biopsies with a positive deep margin suggest inadequate...
BACKGROUND
The staging of patients with primary melanoma is dependent on adequate sampling of the tumor thickness. Initial biopsies with a positive deep margin suggest inadequate sampling, potentially limiting accurate staging and affecting treatment decisions.
METHODS
To determine the efficacy of shave biopsy to adequately sample the tumor, we retrospectively reviewed our pathology database for original pathology reports of primary melanomas accessioned between 01/01/04 and 6/30/05. The biopsies were evaluated by technique, the presence of tumor at the margins of the specimen, and specimen thickness.
RESULTS
We identified 240 cases of primary melanoma; 223/240 were analyzable. The specimens were divided by biopsy technique (excisional, n = 51; punch, n = 44; and shave, n = 128). Shave and punch specimens had a significantly higher percentage of positive margins than excisional specimens (50, 68, and 16%, respectively; P < 0.0001). Shave specimens had a significantly higher percentage of positive deep margins than punch or excisional specimens (22, 7, and 2%, respectively; P = 0.0009). For melanomas
shave specimens had a significantly higher percentage of positive deep margins than punch or excisional specimens (17, 0, and 0%, respectively; P = 0.0014). There was a significant difference in specimen thickness (P = 0.0005), with shave specimens being the thinnest. CONCLUSIONS
The presence of tumor at the lateral margin of punch biopsies is an expected result, since this method is often used to diagnose lesions with a large diameter. The presence of positive deep margins in 22% of shave biopsy specimens compromises the ability of this technique to properly stage patients.
Topics: Biopsy; Databases as Topic; Female; Humans; Incidence; Male; Melanoma; Middle Aged; Neoplasm Staging; Retrospective Studies; Skin; Skin Neoplasms
PubMed: 17119869
DOI: 10.1245/s10434-006-9240-4 -
Journal of the European Academy of... Jul 2011Patients who are referred for Mohs surgery after pre-operative biopsy has been performed show in some cases no clinical or pathological evidence of tumour persistence....
BACKGROUND
Patients who are referred for Mohs surgery after pre-operative biopsy has been performed show in some cases no clinical or pathological evidence of tumour persistence. We have previously shown that 25% of these patients show no residual skin cancer either basal cell carcinoma or squamous cell carcinoma. The reasons for 'disappearance' of the tumour may be true non-persistence or false non-persistence because of wrong-site Mohs surgery.
OBJECTIVE
To determine the incidence of residual basal cell carcinoma after shave biopsy of primary nodular basal cell carcinoma prior to Mohs micrographic surgery.
METHODS
A prospective unblinded study was performed on patients undergoing Mohs surgery for primary nodular basal cell carcinoma. The tumour was removed as a shaved excision using a No. 15 blade at the clinical borders like a shave biopsy (Mohs shave). The bases of the tumors were excised and then sectioned vertically at the middle and cut to the periphery at 10-15 μm intervals till the edge.
RESULTS
Fifty-one patients were evaluated. In 40 patients, residual basal cell carcinoma was found at the base of the shave excision site (78.4%).
CONCLUSIONS
Pre-operative shave biopsy performed during Mohs surgery for primary nodular basal cell carcinoma is 'curative' in 22% of the patients.
Topics: Biopsy; Carcinoma, Basal Cell; Humans; Mohs Surgery; Prospective Studies; Skin Neoplasms
PubMed: 21054570
DOI: 10.1111/j.1468-3083.2010.03881.x -
Journal of the American Academy of... Jun 1985
Topics: Carcinoma, Basal Cell; Curettage; Humans; Methods; Skin Neoplasms
PubMed: 4008707
DOI: 10.1016/s0190-9622(85)80199-7 -
The Journal of Dermatology Jan 2005A 15-year-old boy first noticed multiple firm papules on his right upper chest two years before presenting to our clinic. These papules were densely distributed and...
A 15-year-old boy first noticed multiple firm papules on his right upper chest two years before presenting to our clinic. These papules were densely distributed and showed epidermal nevus-like linear arrangement at some sites. The number, size, and distribution of these papules remained unchanged for one year of our observation. The papules flattened leaving scars and did not recur within a year after one shaving abrasion using a scalpel. Histopathologically, epidermis of the papule displayed acanthosis with elongated rete ridges. Accumulation of mucin was apparent in the papillary and subpapillary dermis. In mucinous nevus, the origin of cells with nevoid proliferation is obscure. In contrast with common collagenous connective tissue nevus, it is hard to define the localized persistent mucin accumulation as a nevoid manifestation. The present case of mucinous nevus might be caused by significantly stimulated glycosaminoglycan synthesis in a kind of epidermal nevus without extreme hyperkeratosis.
Topics: Adolescent; Biopsy; Diagnosis, Differential; Humans; Male; Mucinoses; Nevus, Pigmented; Skin Neoplasms; Thorax
PubMed: 15841658
DOI: 10.1111/j.1346-8138.2005.tb00710.x -
Annals of the Royal College of Surgeons... May 2008Guidelines for suspected malignant melanoma recommend a prompt, full-thickness excision biopsy allowing diagnosis and assessment of the Breslow thickness. Incisional...
INTRODUCTION
Guidelines for suspected malignant melanoma recommend a prompt, full-thickness excision biopsy allowing diagnosis and assessment of the Breslow thickness. Incisional biopsy is acceptable only for extensive facial lentigo maligna or acral melanoma. Punch, shave and other types of biopsies do not allow pathological staging and are, therefore, not recommended.
PATIENTS AND METHODS
A total of 100 referrals for histology-proven malignant melanoma were assessed retrospectively over a 1-year period (2005).
RESULTS
Of the 100 patients included in this study, 52 were male and 48 female. Ages ranged from 18-91 years, with a mean of 63 years. Origin of referrals was: dermatology, 63%; general practitioner (GP), 33%; and other sources in the remaining 4% of cases. Malignant melanoma was suspected in 84% and a benign lesion in remaining 16% of patients. However, only 56% of the patients were seen in our unit within 14 days of the referral as per the 2-week cancer rule. In these 100 patients, various types of biopsy were performed: 50 were referred without biopsy, 17 excision, 20 punch, 3 shave, 1 curettage, and 1 incisional biopsy. The type of biopsy was not recorded in the remaining 3 patients. Of the GP group, 48% were referred without biopsy, 12% had excision and 3% had incisional biopsies. The remaining 30% were punch, shave biopsies, and even curettage, inconsistent with current recommendations. Of the dermatology group, 54% were referred without biopsy, 21% underwent excision biopsy and 22% were punch biopsies. In total, 20 punch biopsies were performed, of which 7 were for lesions on the face ranging from 1.7-25 mm in size. The remaining punch biopsies were for lesions on the trunk or limbs (4-50 mm). Of the 20 punch biopsies performed, Breslow thickness was available in only 9 cases (45%). Sixteen of the punch biopsies were done when malignant melanoma was suspected and lesion otherwise was suitable for excisional biopsy. In the GP group, 3 shave biopsies and 1 curettage were performed, of which malignant melanoma was clinically suspected in one patient. The Breslow thickness was not obtained from any of the shave biopsies or curettage cases. Of the 17 excision biopsies performed, 3 were incompletely excised (2 by dermatology and 1 by GP).
CONCLUSIONS
A significant proportion of biopsies are inappropriate and inconsistent with the malignant melanoma guidelines. Punch biopsies are performed even when malignant melanoma is clinically suspected and excision biopsy is feasible. Only a small proportion of patients appear to be seen on an urgent basis within 14 days of referral. Such factors can lead to a delay in diagnosis, subsequent definitive treatment and adversely affect patient outcome. This study identifies a need to provide feedback and education to sources of malignant melanoma referrals.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Feasibility Studies; Female; Humans; Male; Melanoma; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Skin; Skin Neoplasms
PubMed: 18492398
DOI: 10.1308/003588408X285856 -
JAAD International Jun 2023
PubMed: 37138829
DOI: 10.1016/j.jdin.2023.02.012 -
Dermatologic Surgery : Official... Dec 2017
Topics: Biopsy; Humans; Nails; Surgical Instruments
PubMed: 28930793
DOI: 10.1097/DSS.0000000000001141 -
Journal of Drugs in Dermatology : JDD Jul 2018Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can...
INTRODUCTION
Biopsies of atypical melanocytic nevi are among the most commonly performed procedures by dermatologists. Margin assessment is often used to guide re-excision, but can be a point of confusion as negative margins reported in the planes of sections examined do not always reflect complete removal of a lesion. This study investigates the rates of false negative margins after both punch and shave biopsies.
METHODS
We performed a retrospective analysis of 50 consecutive punch and shave biopsy specimens (1) diagnosed as DN, and (2) reported as having clear margins in the planes of section examined. Identified specimen blocks were then sectioned through to examine true margin involvement.
RESULTS
Of the 50 specimens identified, 20% (n = 10) were found to have positive margins upon additional sectioning. We found no difference between the groups with respect to biopsy technique, type of nevus, degree of atypia, or gender.
CONCLUSION
This study observed false negative peripheral margin status in a sizeable proportion of biopsy specimens, which did not vary significantly based on biopsy technique or pathologic characteristics. This finding reflects a limitation of standard tissue processing, in which a limited proportion of the true margin is evaluated, and may be of note to many dermatologists who base their decision to re-excise on the reporting of margin involvement. J Drugs Dermatol. 2018;17(7):810-812.
Topics: Adult; Biopsy; Clinical Decision-Making; Dysplastic Nevus Syndrome; False Negative Reactions; Female; Humans; Male; Margins of Excision; Middle Aged; Nevus, Pigmented; Retrospective Studies; Sex Factors; Skin; Skin Neoplasms; Young Adult
PubMed: 30005107
DOI: No ID Found -
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