Background: While excisional biopsy represents the gold standard for diagnosis of atypical pigmented lesions, shave biopsy is an increasingly popular method. Through a systematic review, we investigate the impact of shave biopsy on tumor staging and prognosis in order to meaningfully inform management recommendations for these patients.
Methods: A systematic review of MEDLINE, Embase and Cochrane library databases was conducted for relevant reports dating back to 2010. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies.
Results: Fourteen articles were critically assessed. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed positive deep margin in 42.9% of shave biopsies. Tumor upstaging following WLE occurred in 7.7% of this cohort, and additional treatment was subsequently indicated for 2.3% in the form of either further excision and/or sentinel lymph node biopsy. There was heterogeneity across studies in all outcomes. Four studies reported survival, while none found significant difference in disease free or overall survival between shave biopsy and other modalities.
Discussion: Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin. However, this translated into a change in tumor stage or treatment recommendations in a relatively few, with no impact on local recurrence or survival.
Conclusion: Advocates promote shave biopsy for the early diagnosis of melanoma, facilitating early management and improved overall outcome, and the prevalence of this technique is increasing. Based on our meta-analysis, we provide practical narratives to assist the surgical oncologist’s informed discussion of management for patients presenting with a new melanoma diagnosis in this scenario.