Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC.
Monash University Central Clinical School, Melbourne, VIC.
Med J Aust. 2019 Sep;211(5):213-218. doi: 10.5694/mja2.50289. Epub 2019 Jul 22.
To assess changes in the choice of skin biopsy technique for assessing invasive melanoma in Victoria, and to examine the impact of partial biopsy technique on the accuracy of tumour microstaging.
Retrospective cross-sectional review of Victorian Cancer Registry data on invasive melanoma histologically diagnosed in Victoria during 2005, 2010, and 2015.
SETTING, PARTICIPANTS: 400 patients randomly selected from each of the three years, stratified by final tumour thickness: 200 patients with thin melanoma (< 1.0 mm), 100 each with intermediate (1.0-4.0 mm) and thick melanoma (> 4.0 mm).
Partial and excisional biopsies, as proportions of all skin biopsies; rates of tumour base transection and T-upstaging, and mean tumour thickness underestimation following partial biopsy.
833 excisional and 337 partial diagnostic biopsies were undertaken. The proportion of partial biopsies increased from 20% of patients in 2005 to 36% in 2015 (P < 0.001); the proportion of shave biopsies increased from 9% in 2005 to 20% in 2015 (P < 0.001), with increasing rates among dermatologists and general practitioners. Ninety-four of 175 shave biopsies (54%) transected the tumour base; wide local excision subsequently identified residual melanoma in 65 of these cases (69%). Twenty-one tumours diagnosed by shave biopsy (12%) were T-upstaged. With base-transected shave biopsies, tumour thickness was underestimated by a mean 2.36 mm for thick, 0.48 mm for intermediate, and 0.07 mm for thin melanomas.
Partial biopsy, particularly shave biopsy, was increasingly used for diagnosing invasive melanoma between 2005 and 2015. Shave biopsy has a high rate of base transection, reducing the accuracy of tumour staging, which is crucial for planning appropriate therapy, including definitive surgery and adjuvant therapy.
评估维多利亚州评估浸润性黑色素瘤时皮肤活检技术选择的变化，并研究部分活检技术对肿瘤微分期准确性的影响。
对 2005 年、2010 年和 2015 年维多利亚癌症登记处诊断为浸润性黑色素瘤的组织学数据进行回顾性横断面研究。
地点、参与者：从这三年中每个年份随机抽取 400 名患者，按最终肿瘤厚度分层：200 名患者患有薄型黑色素瘤（<1.0mm），100 名患者患有中间型（1.0-4.0mm）和厚型黑色素瘤（>4.0mm）。
部分和切除活检，占所有皮肤活检的比例；肿瘤基底横切和 T 期升级的发生率，以及部分活检后肿瘤厚度的平均低估率。
共进行了 833 例切除和 337 例部分诊断性活检。部分活检的比例从 2005 年的 20%增加到 2015 年的 36%（P<0.001）；刮除活检的比例从 2005 年的 9%增加到 2015 年的 20%（P<0.001），皮肤科医生和全科医生中的比例也在增加。175 例刮除活检中有 94 例（54%）横切肿瘤基底；随后广泛局部切除在这些病例中有 65 例（69%）发现残余黑色素瘤。21 例（12%）通过刮除活检诊断的肿瘤 T 期升级。对于厚型、中间型和薄型黑色素瘤，横切的基底刮除活检平均低估肿瘤厚度分别为 2.36mm、0.48mm 和 0.07mm。
2005 年至 2015 年间，部分活检，特别是刮除活检，越来越多地用于诊断浸润性黑色素瘤。刮除活检基底横切率较高，降低了肿瘤分期的准确性，这对制定适当的治疗计划至关重要，包括明确的手术和辅助治疗。
