Plantar erythema nodosum of childhood

Abstract

To the Editor: Wereadwithinterest the recentarticle by BrodlandandZitel1i(JAM ACADDERMATOL 1993;27:18); wealsoenjoyed the accompanying editorial.' The editorialemphasized the possible deleteriouseffect that an incisional biopsy mayhaveonthe subsequentclinicalbehavior ofa cutaneous melanoma. We havereviewed more than 1000patientswith clinical stage 1 invasive cutaneous melanoma, all of whom have been followed up for a minimum of 5 years.' Of thesepatients, 8.8% had an initial incisional biopsy, 26.9% a narrow marginexcision biopsy, subsequently followed bya wider marginbiopsy; the remaining 64.3% hada widemargin excision at the start. Analysis of the data showed that an initialbiopsydid not adversely affecttheprognosis in terms oflocalrecurrence and mortality. The prognosis wasrelated to tumor thickness, ageand sexof patient, and not to biopsy technique. However, incisional biopsy rendered 40% of the lesions not fully assessable by current histopathologic criteria. This was far higherthan forother biopsytechniques. We recommend that all lesions suspected of being a melanoma should havea primaryexcisional rather than incisional biopsy to avoid compromising the histologic assessment, for this reason alone.