Aims:
Current guidelines support complete excision for initial diagnosis of malignant melanoma. Shave excisions are more cost effective, quicker, often same day procedures with minimal to no downtime. However, multiple studies suggest a high incidence of base transection with shave excisions.
This study aims to retrospectively analyse melanomas histologically confirmed by shave procedure. We postulate that base transection incidence increases with lesions on the face and/or palpably raised and/or performing too superficial a shave.
Method:
We performed a retrospective cohort review of a consecutive series of adult patients with histologically confirmed melanoma after shave procedure reported by IQ Pathology (SEQ) from Dec 2021 to March 2022. Histopathology report review of 150 patients was conducted.
Results:
A total of 153 lesions were analysed from 150 adult patients. Shave proceduralists were general practitioners (79%), dermatologists (19%) and plastic surgeons (2%). Six lesions (4%) had deep margin involvement. Two of these lesions were palpably raised and ulcerated and thus unsuitable for a shave excision procedure. Predictably these were around 2 mm thick. The other four were less than 1 mm thick and base transection was a consequence of a thin shave specimen.
Table1
|
Age |
Gender |
Site |
Clark Level |
Breslow Thickness |
Ulceration |
Raised |
|
60 |
M |
chest |
4 |
0.9 |
absent |
no |
|
63 |
F |
arm |
2 |
0.3 |
absent |
no |
|
81 |
M |
temple |
3 |
0.6 |
absent |
no |
|
58 |
M |
arm |
3 |
0.7 |
absent |
no |
|
80 |
F |
back |
4 |
1.9 |
yes |
yes |
|
42 |
M |
leg |
4 |
2.1 |
yes |
yes |
Conclusion:
The low overall rate of base transections noted in our review supports the use of shave procedure in diagnosis of malignant melanoma. Avoiding raised lesions and shaving to the level of deep dermis would have avoided all base transections in this series. Shave excisions will rarely result in base transections in carefully selected lesions and good surgical technique.