Accuracy of initial biopsy of melanoma and effects on staging, treatment & prognosis

Abstract

How accurate is initial biopsy for melanoma? How often is a consultative reading or surgical excision significantly different than initial biopsy? How does this difference in histologic information affect staging/treatment/prognosis? Are there any established guidelines for dealing with differing histologic information for staging? These are some of the questions we attempt to answer through a retrospective review of the St. Louis University (SLU) Melanoma Database from June 2001 thru May 2003. A total of 59 cases of primary cutaneous melanoma were reviewed retrospectively. Breslow’s depth (BD) on initial biopsy report was compared with BD on consult report and WLE path report if residual tumor was seen for determination of accuracy. All cases in SLU Melanoma Database (n = 72) were reviewed. Patients with in-situ melanoma (n = 13) were excluded. Remaining patients with invasive melanoma (n = 59) were identified and their records reviewed for initial biopsy type, initial BD, consult BD, WLE residual BD, and other clinical information including presence of ulceration & clinical stage according to 2002 AJCC staging system. Accuracy was defined as Breslow’s depth in initial biopsy greater than or equal to that in 2nd biopsy or excision. Overall accuracy of initial biopsy was found to be 93% in this series. How accurate is initial biopsy for melanoma? How often is a consultative reading or surgical excision significantly different than initial biopsy? How does this difference in histologic information affect staging/treatment/prognosis? Are there any established guidelines for dealing with differing histologic information for staging? These are some of the questions we attempt to answer through a retrospective review of the St. Louis University (SLU) Melanoma Database from June 2001 thru May 2003. A total of 59 cases of primary cutaneous melanoma were reviewed retrospectively. Breslow’s depth (BD) on initial biopsy report was compared with BD on consult report and WLE path report if residual tumor was seen for determination of accuracy. All cases in SLU Melanoma Database (n = 72) were reviewed. Patients with in-situ melanoma (n = 13) were excluded. Remaining patients with invasive melanoma (n = 59) were identified and their records reviewed for initial biopsy type, initial BD, consult BD, WLE residual BD, and other clinical information including presence of ulceration & clinical stage according to 2002 AJCC staging system. Accuracy was defined as Breslow’s depth in initial biopsy greater than or equal to that in 2nd biopsy or excision. Overall accuracy of initial biopsy was found to be 93% in this series.