Melanoma biopsy: Difference between revisions
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{{CMG}} {{AE}} {{YD}}; {{SSK}} | {{CMG}} {{AE}} {{YD}}; {{SSK}} | ||
==Overview== | ==Overview== | ||
All [[Patient|patients]] with suspected melanoma require [[biopsy]]. Findings on [[biopsy]] may distinguish the sub-type and the [[Cancer staging|stage]] of melanoma. | |||
==Approach to Patients with Suspected Melanoma== | |||
The following [[algorithm]] illustrates the approach to [[Patient|patients]] with suspected melanoma.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343 }} </ref> | |||
{{familytree/start |summary=Approach to melanoma}} | |||
{{familytree | | | | | | | | | A01 | | | | | | | | | | | | | A01=<div style="width: 7em; padding:1em;">Suspicious pigmented lesion</div>}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | B01 | | | | | | | | | | | | | B01=<div style="width: 7em; padding:1em;">Biopsy</div>}} | |||
{{familytree | | | | | | | |,|-|^|-|.| | | | | | | | | | | | }} | |||
{{familytree | | | | | | | |!| | | C01 | | | | | | | | | | | C01=<div style="width: 7em; padding:1em;">Inadequate</div>}} | |||
{{familytree | | | | | | | |!| | | |!| | | | | | | | | | | | }} | |||
{{familytree | | | | | | | |!| | | D01 | | | | | | | | | | | D01=<div style="width: 7em; padding:1em;">Rebiopsy</div>}} | |||
{{familytree | | | | | | | |`|-|v|-|'| | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | E01 | | | | | | | | | | | | | E01=<div style="width: 7em; padding:1em;">Melanoma confirmed</div>}} | |||
{{familytree | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|.| | }} | |||
{{familytree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | F01=<div style="width: 7em; padding:1em;">Breslow thickness</div>|F02=<div style="width: 7em; padding:1em;">Ulceration status</div>|F03=<div style="width: 7em; padding:1em;">Mitotic rate</div>|F04=<div style="width: 7em; padding:1em;">Depth and peripheral margin status</div>|F05=<div style="width: 7em; padding:1em;">Presence of satellitosis</div>|F06=<div style="width: 7em; padding:1em;">Clark level for lesions ≤ 1 mm</div>}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | G01 | | | | | | | | | | | | | G01=<div style="width: 7em; padding:1em;">Reassessment with complete physical examination, including neurological exam and lymph node assessment</div>}} | |||
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | H01 | | | | | | | | | | | | | H01=<div style="width: 7em; padding:1em;">[[Melanoma staging|Staging]]</div>}} | |||
{{familytree/end}} | |||
==Biopsy== | ==Biopsy== | ||
*Patients who have lesions suspected to be melanoma should always be biopsied. | *[[Patient|Patients]] who have [[Lesion|lesions]] suspected to be melanoma should always be [[Biopsy|biopsied]].<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343 }} </ref> | ||
*An excisional biopsy (either elliptical, punch, or | *An [[Biopsy|excisional biopsy]] (either elliptical, punch, or saucerization) of the thickest portion of the [[lesion]] with 1-3 mm margins is recommended.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343 }} </ref> | ||
*Shave biopsy is acceptable only when the index of suspicion for melanoma is low. | *Shave [[biopsy]] is acceptable only when the index of suspicion for melanoma is low.<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343 }} </ref> | ||
*The following should be reported when a biopsy is being reported: | *The following should be reported when a [[biopsy]] is being reported:<ref name="pmid23584343">{{cite journal| author=Coit DG, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, Daud A et al.| title=Melanoma, version 2.2013: featured updates to the NCCN guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 4 | pages= 395-407 | pmid=23584343 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23584343 }} </ref> | ||
:*Location | :*Location | ||
:*Regression | :*Regression | ||
:*Tumor infiltrating lymphocytes | :*[[Tumor]] infiltrating [[Lymphocyte|lymphocytes]] | ||
:*Breslow | :*[[Breslow's depth]] and vertical growth phase | ||
:*Histologic ulceration | :*[[Histology|Histologic]] [[Ulcer|ulceration]] | ||
:*Clark level | :*Clark level | ||
:*Angiolymphatic invasion | :*Angiolymphatic invasion | ||
:*Neurotropism | :*Neurotropism | ||
:*Histologic subtype | :*[[Histology|Histologic]] subtype | ||
<br> | |||
To view the histopathologic characteristic features of all subtypes of melanoma, click [[Melanoma pathophysiology#Pathology|'''here''']]. | |||
==References== | |||
== | |||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Dermatology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 20:46, 3 January 2019
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Melanoma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Melanoma biopsy On the Web |
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American Roentgen Ray Society Images of Melanoma biopsy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.
Overview
All patients with suspected melanoma require biopsy. Findings on biopsy may distinguish the sub-type and the stage of melanoma.
Approach to Patients with Suspected Melanoma
The following algorithm illustrates the approach to patients with suspected melanoma.[1]
Suspicious pigmented lesion | |||||||||||||||||||||||||||||||||||||||||||||||
Biopsy | |||||||||||||||||||||||||||||||||||||||||||||||
Inadequate | |||||||||||||||||||||||||||||||||||||||||||||||
Rebiopsy | |||||||||||||||||||||||||||||||||||||||||||||||
Melanoma confirmed | |||||||||||||||||||||||||||||||||||||||||||||||
Breslow thickness | Ulceration status | Mitotic rate | Depth and peripheral margin status | Presence of satellitosis | Clark level for lesions ≤ 1 mm | ||||||||||||||||||||||||||||||||||||||||||
Reassessment with complete physical examination, including neurological exam and lymph node assessment | |||||||||||||||||||||||||||||||||||||||||||||||
Biopsy
- Patients who have lesions suspected to be melanoma should always be biopsied.[1]
- An excisional biopsy (either elliptical, punch, or saucerization) of the thickest portion of the lesion with 1-3 mm margins is recommended.[1]
- Shave biopsy is acceptable only when the index of suspicion for melanoma is low.[1]
- The following should be reported when a biopsy is being reported:[1]
- Location
- Regression
- Tumor infiltrating lymphocytes
- Breslow's depth and vertical growth phase
- Histologic ulceration
- Clark level
- Angiolymphatic invasion
- Neurotropism
- Histologic subtype
To view the histopathologic characteristic features of all subtypes of melanoma, click here.