The impact of biopsy technique on upstaging, residual disease, and outcome in cutaneous melanoma

Genevive L. Egnatios, Amylou C. Dueck, James B. MacDonald, Susan D. Laman, Karen E. Warschaw, David J. Dicaudo, Shari A. Nemeth, Aleksandar Sekulic, Richard J. Gray, Nabil Wasif, Barbara A. Pockaj

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Background: After skin biopsy of malignant melanoma, the findings in the subsequent wide local excision (WLE) sometimes result in upgrading of the T-category. Herein, we examine the influence of biopsy technique on residual disease in melanoma WLE specimens and on upstaging. Methods: We performed a retrospective review of data from malignant melanoma patients who underwent sentinel lymph node biopsy between 1997 and 2010. Results: A total of 609 patients were biopsied by shave (51%), punch (19%), and excision (30%). Residual disease was seen in 240 patients (39%) at WLE, of whom 60% had undergone shave biopsy. Fifty-nine patients had a T-category upgrade after WLE (10% of all patients); 64% were sampled by shave. Seven percent of patients with a T-category upgrade had negative margins initially. Positive biopsy margin and greater thickness predicted T-category upgrade. Conclusions: Partial biopsy for melanoma resulted in more residual disease at WLE and a higher rate of T-category upgrade. Moreover, the presence of negative margins at biopsy did not ensure lack of residual disease.

Original languageEnglish (US)
Pages (from-to)771-778
Number of pages8
JournalAmerican journal of surgery
Issue number6
StatePublished - Dec 2011


  • Biopsy
  • Margins
  • Melanoma
  • Residual disease
  • T-category upgrade
  • Wide local excision

ASJC Scopus subject areas

  • Surgery


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