Effect of changes in Breslow thickness between the initial punch biopsy results and final pathology reports in acral lentiginous melanoma patients

Tae Hyung Kim,You Chan Kim,Jin Cheol Kim,Ji Eun Kwon,Jee Woong Choi

doi:10.1038/s41598-021-99422-6

Tae Hyung Kim, You Chan Kim + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-99422-6

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Abstract

Acral lentiginous melanoma (ALM) is the most common subtype of cutaneous melanoma among Asians; punch biopsy is widely performed for its diagnosis. However, the pathologic parameters evaluated via punch biopsy may not be sufficient for predicting disease prognosis compared to the parameters evaluated via excisional biopsy. We investigated whether changes in Breslow thickness (BT) between initial punch biopsy results and final pathology reports can affect the prognosis of ALM. Pathologic parameters were recorded from specimens acquired through the initial punch biopsy and wide excision. Patients were classified into two groups based on a change in Breslow depth: the BT increased or decreased on comparing the samples from the initial punch biopsy and final wide excision. We compared clinical characteristics, and a Cox regression model was used to identify independent prognostic factors influencing melanoma-specific death (MSD). Changes in BT did not affect MSD (hazard ratio [HR]: 0.55, P = 0.447). In multivariate analysis, a higher BT (> 2 mm) (HR: 9.93, P = 0.046) and nodal metastasis (HR: 5.66, P = 0.041) were significantly associated with an increased MSD risk. The use of punch biopsy did not affect MSD despite the inaccuracy of BT measurement as long as ALM was accurately diagnosed.

Highlights

Acral lentiginous melanoma (ALM) is the most common subtype of cutaneous melanoma among Asians; punch biopsy is widely performed for its diagnosis
We investigated whether changes in Breslow thickness (BT) between the initial punch biopsy results and final pathology reports affected the prognosis of ALM patients
Group 2 had an increased risk of melanoma-specific death (MSD); there was no statistical significance on comparison with group 1 (HR: 1.30, 95% confidence intervals (CIs): 0.38–4.22, P = 0.993)

Summary

Introduction

Acral lentiginous melanoma (ALM) is the most common subtype of cutaneous melanoma among Asians; punch biopsy is widely performed for its diagnosis. Patients were classified into two groups based on a change in Breslow depth: the BT increased or decreased on comparing the samples from the initial punch biopsy and final wide excision. An excisional biopsy can encompass a sufficient depth that would prevent transection at the base of the lesion This method may not be suitable in certain circumstances: for instance, when the tumor is too large to be primarily excised or is located in cosmetically or functionally sensitive areas such as the palm, sole, or distal d igits[10,11,12,13]. Clinicians can be faced with inaccurate surgical decision-making and prognosis based on incomplete histologic information[11]

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