A Retrospective Comparison Between Preoperative and Postoperative Breslow Depth in Primary Cutaneous Melanoma: How Preoperative Shave Biopsies Affect Surgical Management

Background: Accurate histopathologic staging of preoperative biopsy specimens is critical for determining optimal surgical management for patients with primary cutaneous melanoma. The American Academy of Dermatology (AAD) and National Comprehensive Cancer Network (NCCN) currently list narrow excisional biopsy (fusiform excision) as the preferred technique for biopsying lesions suspicious for melanoma. However, preoperative shave biopsies are routinely performed on lesions concerning for melanoma in many medical centers out of convenience. Objective: The current retrospective chart review was performed to determine whether preoperative shave biopsies are acceptable for evaluating lesions suspicious for melanoma and whether shave biopsies lead to underestimation of Breslow depth great enough to require additional surgeries. Methods: A consecutive sample of 242 primary cutaneous melanoma cases surgically excised between January 1, 2004 and December 31, 2010 in a private practice setting was analyzed for this study. Results: Breslow depth underestimation occurred in 8 of 226 shave biopsy cases (3.5%). Differences in preoperative and postoperative Breslow depths in shave biopsy cases were not statistically significant (P=0.48). Underestimation of Breslow depth, melanoma transection, positive deep biopsy margins, and tumor upstaging did not lead to statistically significant changes in surgical management. Conclusions: Based on the results from the current study and available literature, the authors posit that preoperative deep excisional shave biopsies performed by dermatologists are accurate for determining Breslow depth and for planning surgical management of melanomas.