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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1985 Mar;67(2):75–78.

Biopsy procedures, primary wide excisional surgery and long term prognosis in primary clinical stage I invasive cutaneous malignant melanoma.

R W Griffiths, J C Briggs
PMCID: PMC2498232  PMID: 3977262

Abstract

281 patients managed for primary clinical Stage I invasive cutaneous malignant melanoma at one Plastic Surgery Unit were followed up to a minimum of 10 years after primary surgical treatment. Sixty-three (23%) had received an initial biopsy procedure prior to definitive wide margin excisional surgery. One third of all lesions initially treated by so called incisional biopsy were rendered histologically unassessable on current histopathological criteria. Incisional biopsy significantly interfered with the accurate histopathological staging of the tumours. Of the assessable incisional biopsy specimens the majority were greater than 4.0 mm thick. When the incidences of local tumour recurrence and mortality were related specifically to maximal tumour thickness of the primary lesion, prognosis at minimum follow up of 10 years was not significantly different between patients treated initially by either incisional biopsy, minimal margin excisional biopsy or primary wide excisional surgery. Whether or not incisional biopsy adversely affects prognosis in cutaneous malignant melanoma, the technique should be avoided since it compromises accurate histopathological microstaging which represents one of our most valuable prognostic guides. Clinical doubt over the diagnosis of cutaneous malignant melanoma should be resolved by a total excisional biopsy of the lesion in question.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ackerman A. B., Scheiner A. M. How wide and deep is wide and deep enough? A critique of surgical practice in excisions of primary cutaneous malignant melanoma. Hum Pathol. 1983 Sep;14(9):743–744. doi: 10.1016/s0046-8177(83)80298-6. [DOI] [PubMed] [Google Scholar]
  2. Aitken D. R., Clausen K., Klein J. P., James A. G. The extent of primary melanoma excision. A re-evaluation--how wide is wide? Ann Surg. 1983 Nov;198(5):634–641. doi: 10.1097/00000658-198311000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Balch C. M., Soong S. J., Milton G. W., Shaw H. M., McGovern V. J., Murad T. M., McCarthy W. H., Maddox W. A. A comparison of prognostic factors and surgical results in 1,786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia. Ann Surg. 1982 Dec;196(6):677–684. doi: 10.1097/00000658-198212001-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Balch C. M., Soong S. J., Murad T. M., Ingalls A. L., Maddox W. A. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery. 1979 Aug;86(2):343–351. [PubMed] [Google Scholar]
  5. Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970 Nov;172(5):902–908. doi: 10.1097/00000658-197011000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Breslow A. Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg. 1975 Nov;182(5):572–575. doi: 10.1097/00000658-197511000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. CADE S. Malignant melanoma. Ann R Coll Surg Engl. 1961 Jun;28:331–366. [PMC free article] [PubMed] [Google Scholar]
  8. Clark W. H., Jr, From L., Bernardino E. A., Mihm M. C. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Res. 1969 Mar;29(3):705–727. [PubMed] [Google Scholar]
  9. Drzewiecki K. T., Ladefoged C., Christensen H. E. Biopsy and prognosis for cutaneous malignant melanomas in clinical stage I. Scand J Plast Reconstr Surg. 1980;14(2):141–144. doi: 10.3109/02844318009106699. [DOI] [PubMed] [Google Scholar]
  10. Eldh J., Boeryd B., Peterson L. E. Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis. Scand J Plast Reconstr Surg. 1978;12(3):243–255. doi: 10.3109/02844317809013000. [DOI] [PubMed] [Google Scholar]
  11. Eldh J. Excisional biopsy and delayed wide excision versus primary wide excision of malignant melanoma. Scand J Plast Reconstr Surg. 1979;13(2):341–345. doi: 10.3109/02844317909013079. [DOI] [PubMed] [Google Scholar]
  12. Epstein E., Bragg K., Linden G. Biopsy and prognosis of malignant melanoma. JAMA. 1969 May 26;208(8):1369–1371. [PubMed] [Google Scholar]
  13. Griffiths R. W., Briggs J. C., Hiles R. W. Clinical diagnostic accuracy in the management of primary Stage I cutaneous malignant melanoma in a plastic surgery unit. Bristol Med Chir J. 1984 Apr;99(370):55–60. [PMC free article] [PubMed] [Google Scholar]
  14. Harris M. N., Gumport S. L. Total excision biopsy for primary malignant melanoma. JAMA. 1973 Oct 15;226(3):354–355. doi: 10.1001/jama.1973.03230030066028. [DOI] [PubMed] [Google Scholar]
  15. Ironside P., Pitt T. T., Rank B. K. Malignant melanoma: some aspects of pathology and prognosis. Aust N Z J Surg. 1977 Feb;47(1):70–75. doi: 10.1111/j.1445-2197.1977.tb03938.x. [DOI] [PubMed] [Google Scholar]
  16. Jones W. M., Williams W. J., Roberts M. M., Davies K. Malignant melanoma of the skin: prognostic value of clinical features and the role of treatment in 111 cases. Br J Cancer. 1968 Sep;22(3):437–451. doi: 10.1038/bjc.1968.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Macy-Roberts E., Ackerman A. B. A critique of techniques for biopsy of clinically suspected malignant melanomas. Am J Dermatopathol. 1982 Oct;4(5):391–398. doi: 10.1097/00000372-198210000-00003. [DOI] [PubMed] [Google Scholar]
  18. McGovern V. J., Shaw H. M., Milton G. W., Farago G. A. Prognostic significance of the histological features of malignant melanoma. Histopathology. 1979 Sep;3(5):385–393. doi: 10.1111/j.1365-2559.1979.tb03020.x. [DOI] [PubMed] [Google Scholar]
  19. Olsen G. The malignant melanoma of the skin. New theories based on a study of 500 cases. Acta Chir Scand Suppl. 1966;365:1–222. [PubMed] [Google Scholar]
  20. Paslin D. A. The effects of biopsy on the incidence of metastases in hamsters bearing malignant melanoma. J Invest Dermatol. 1973 Jul;61(1):33–38. doi: 10.1111/1523-1747.ep12674122. [DOI] [PubMed] [Google Scholar]
  21. Rampen F. H., van Houten W. A., Jop W. C. Incisional procedures and prognosis in malignant melanoma. Clin Exp Dermatol. 1980 Sep;5(3):313–320. doi: 10.1111/j.1365-2230.1980.tb01709.x. [DOI] [PubMed] [Google Scholar]
  22. Roses D. F., Ackerman A. B., Harris M. N., Weinhouse G. R., Gumport S. L. Assessment of biopsy techniques and histopathologic interpretations of primary cutaneous malignant melanoma. Ann Surg. 1979 Mar;189(3):294–297. doi: 10.1097/00000658-197903000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]

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