Hensin Tsao, MD, PhD


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In This Article

Abstract and Introduction


Partial punch biopsies are risky in pigmented lesions.


Although the recommended biopsy technique for pigmented lesions is excision with narrow margins, punch or shave biopsies are commonly employed. However, the accuracy of these sampling methods is not clear. Investigators in Australia conducted a large study to establish the effectiveness of punch or shave biopsies for diagnosing melanoma.

The researchers compared initial pathology reports of 2127 excisional biopsies, 163 punch biopsies, and 180 shave biopsies performed in patients referred to a melanoma service from 1995 to 2006, with definitive excisions performed by the tertiary service. They classified 2252 diagnoses as correct (91.2%); 135 as false-positive misdiagnoses (5.5%); and 83 as false-negative misdiagnoses (3.4%), including 37 (1.5%) associated with an adverse outcome. An adverse outcome was defined as the persistence or progression of the primary melanoma or the development of nodal or distant metastasis. Most critically, punch biopsies were strongly associated both with false-negative misdiagnoses (P<0.001) and with adverse outcomes (P<0.001). Acral lentiginous melanoma, desmoplastic melanoma, and nevoid melanoma were also associated with false-negative readings. Both punch and shave biopsies increased the chances of inaccurate microstaging compared with excisional biopsy (P<0.001); tumor thickness was the most important determinant of microstaging inaccuracy.


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