University of Oklahoma Health Sciences Center

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Author/s:

Shellenberger, R.A., Fayyaz, F., Sako, Z., Tawagi, K., Scheidel, C., Nabhan, M.

Date Added:

July 21, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Clinic

Publication Date:

July 15, 2020

URL:

Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.mayocpiqo.2020.04.005

MeSH

Melanoma, Cutaneous Malignant

Melanoma

Skin Neoplasms

biopsy

RPR Commentary

This meta-analysis confirmed the recommendation that a full thickness excisional biopsy is the preferred method for determining whether a skin lesion is a malignant melanoma. Punch biopsy is associated with a small but statistically significant increase in mortality. James W. Mold, MD, MPH

Abstract

We performed a systematic review and meta-analysis to examine the relationship between the type of biopsy technique employed in the diagnosis of cutaneous melanoma and 4 clinically important outcomes: melanoma-specific mortality, all-cause mortality, Breslow tumor depth, or melanoma recurrence. Our database was obtained by searching PubMed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Library from inception until December 6, 2019. Studies were identified that compared biopsy techniques used to diagnose cutaneous melanoma with any of our study outcomes. We included 7 observational studies for our meta-analysis after screening 3231 titles and abstracts. Pooled data identified a significantly higher all-cause mortality in the punch biopsy group (risk ratio [RR], 1.520; P=.02). A higher, but nonsignificant, rate of melanoma-specific mortality (RR, 1.96; P=.22) and melanoma recurrence (RR, 1.20; P=.186) was also found for the punch biopsy group. Breslow tumor thickness was not significantly lower for punch incision (standardized mean difference, −0.42; P=.27). We found limited evidence for differences in clinically important outcomes across the spectrum of the most common methods employed in clinical practice for the initial diagnosis of cutaneous melanoma. A small, but significant, increase (P=.02) in all-cause mortality with punch biopsies was not seen for the other outcomes and was most likely due to small sample sizes and demographic differences in the included studies and unlikely represents a clinically important outcome. Our findings support the use of existing clinical practice guidelines for evaluating pigmented lesions suspicious for cutaneous melanoma.

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