Shave Biopsy Useful for Initial Evaluation of Melanoma

A shave biopsy is a reasonably safe and accurate method for the initial diagnosis of melanoma, according to a new study.

Researchers at the Moffitt Cancer Center (Tampa, FL, USA) and the University of Florida (UFL; Gainesville, USA) retrospectively analyzed 600 consecutive patients who underwent a shave biopsy for suspicious skin lesions between 2006 and 2009. The researchers found that presumptive pre-shave diagnosis of melanoma was suspected in only 25% of these patients. After definitive surgical wide excision was performed, 133 (22%) had residual melanoma in the surgical excision specimen. However, the detection of residual melanoma in these patients only resulted in subsequent upstaging in T-stage in a small group of 18 (3%) patients, showing that T-stage and depth data obtained through shave biopsy were accurate in 97% of all patients.

According to the researchers, while there are advantages and disadvantages to consider when comparing excisional, punch, and shave biopsies of skin lesions, the disadvantages of shave biopsies remain largely cosmetic. Since shave biopsies do not require sutures for closure, a depressed, hypopigmented, or hyperpigmented scar may sometimes occur. Punch biopsies present physicians with limitations with regard to the size of the biopsy tools available to accommodate an accurate biopsy, as best practices generally recommend excision of some normal appearing skin at the edges of the skin lesion in question. The study was published in the April 2011 issue of the Journal of the American College of Surgeons.

"The diagnosis of melanoma can be extremely challenging, even for the most experienced health care professional," said lead author associate professor Jonathan Zager, MD. "Although traditional excisional biopsy remains the gold standard for the diagnosis of suspicious skin lesions, where a rim of normal appearing skin can be excised with the specimen (especially when melanoma is suspected), our results show shave biopsies may be used as a first-line evaluation for skin lesions with minimal impact on T-staging and definitive treatment options."

Shave biopsy is usually done with a small scalpel or a curved razor blade; the technique is skill dependent. Ideally, the razor will shave only a small fragment of protruding tumor and leaving the skin relatively flat after the procedure. Hemostasis is obtained using light electrocautery, Monsel's solution, or aluminum chloride. This is the ideal method of diagnosis for basal cell cancer. It can be used to diagnose squamous cell carcinoma and melanoma-in-situ, but an understanding of the growth of these last two cancers should be considered before one uses the shave method. Hemostasis for the shave technique can be difficult, as a small shave biopsy often ends up being a large burn defect when the surgeon tries to control the bleeding with electrocautery alone. Pressure dressing or chemical astringent can help in hemostasis in patients taking anticoagulants.

Related Links:
Moffitt Cancer Center
University of Florida