TY - JOUR
T1 - The Devil’s in the Details
T2 - Discrepancy Between Biopsy Thickness and Final Pathology in Acral Melanoma
AU - Lee, Ann Y.
AU - Friedman, Erica B.
AU - Sun, James
AU - Potdar, Aishwarya
AU - Daou, Hala
AU - Farrow, Norma E.
AU - Farley, Clara R.
AU - Vetto, John T.
AU - Han, Dale
AU - Tariq, Marvi
AU - Shapiro, Richard
AU - Beasley, Georgia
AU - Contreras, Carlo M.
AU - Osman, Iman
AU - Lowe, Michael
AU - Zager, Jonathan S.
AU - Berman, Russell S.
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: We hypothesized that initial biopsy may understage acral lentiginous melanoma (ALM) and lead to undertreatment or incomplete staging. Understanding this possibility can potentially aid surgical planning and improve primary tumor staging. Methods: A retrospective review of primary ALMs treated from 2000 to 2017 in the US Melanoma Consortium database was performed. We reviewed pathology characteristics of initial biopsy, final excision specimens, surgical margins, and sentinel lymph node biopsy (SLNB). Results: We identified 418 primary ALMs (321 plantar, 34 palmar, 63 subungual) with initial biopsy and final pathology results. Median final thickness was 1.8 mm (range 0.0–19.0). There was a discrepancy between initial biopsy and final pathology thickness in 180 (43%) patients with a median difference of 1.6 mm (range 0.1–16.4). Final T category was increased in 132 patients (32%), including 47% of initially in situ, 32% of T1, 39% of T2, and 28% of T3 lesions. T category was more likely to be increased in subungual (46%) and palmar (38%) melanomas than plantar (28%, p = 0.01). Among patients upstaged to T2 or higher, 71% had ≤ 1-cm margins taken. Among the 27 patients upstaged to T1b or higher, 8 (30%) did not have a SLNB performed, resulting in incomplete initial staging. Conclusions: In this large series of ALMs, final T category was frequently increased on final pathology. A high index of suspicion is necessary for lesions initially in situ or T1 and consideration should be given to performing additional punch biopsies, wider margin excisions, and/or SLNB.
AB - Purpose: We hypothesized that initial biopsy may understage acral lentiginous melanoma (ALM) and lead to undertreatment or incomplete staging. Understanding this possibility can potentially aid surgical planning and improve primary tumor staging. Methods: A retrospective review of primary ALMs treated from 2000 to 2017 in the US Melanoma Consortium database was performed. We reviewed pathology characteristics of initial biopsy, final excision specimens, surgical margins, and sentinel lymph node biopsy (SLNB). Results: We identified 418 primary ALMs (321 plantar, 34 palmar, 63 subungual) with initial biopsy and final pathology results. Median final thickness was 1.8 mm (range 0.0–19.0). There was a discrepancy between initial biopsy and final pathology thickness in 180 (43%) patients with a median difference of 1.6 mm (range 0.1–16.4). Final T category was increased in 132 patients (32%), including 47% of initially in situ, 32% of T1, 39% of T2, and 28% of T3 lesions. T category was more likely to be increased in subungual (46%) and palmar (38%) melanomas than plantar (28%, p = 0.01). Among patients upstaged to T2 or higher, 71% had ≤ 1-cm margins taken. Among the 27 patients upstaged to T1b or higher, 8 (30%) did not have a SLNB performed, resulting in incomplete initial staging. Conclusions: In this large series of ALMs, final T category was frequently increased on final pathology. A high index of suspicion is necessary for lesions initially in situ or T1 and consideration should be given to performing additional punch biopsies, wider margin excisions, and/or SLNB.
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U2 - 10.1245/s10434-020-08708-y
DO - 10.1245/s10434-020-08708-y
M3 - Article
C2 - 32529271
AN - SCOPUS:85086372978
SN - 1068-9265
VL - 27
SP - 5259
EP - 5266
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 13
ER -