Original article
An objective measure of growth rate using partial biopsy specimens of melanomas that were initially misdiagnosed

Presented in part at the 8th World Congress of Melanoma, Hamburg, Germany, July 17-20, 2013.
https://doi.org/10.1016/j.jaad.2014.04.068Get rights and content

Background

To calculate melanoma rate of growth (ROG), previous studies have relied on subjective patient recall to estimate time delay to diagnosis.

Objective

To objectively calculate ROG by measuring the rate of increase in melanoma thickness between 2 sequential biopsy specimens over time.

Methods

This was a retrospective review of 51 melanomas in which pathologic misdiagnosis of a partial biopsy specimen caused a delay before referral and excisional biopsy between January 1998 and January 2013. ROG was calculated as rate of increase in tumor thickness between biopsy specimens.

Results

The median delay between the 2 biopsy specimens was 27 months (range, 3-89 months). Biopsy specimens of melanomas that were obtained initially in their in situ phase were thinner at excision compared to those that were first obtained as invasive tumors (median, 0.7 vs. 3.2 mm; P < .01) and had a lower ROG (median, 0.04 vs. 0.11 mm/month; P = .05). Faster growth was associated with increased tumor thickness, higher mitotic rate, symptoms, elevation, and amelanosis.

Limitations

Partial biopsy specimens may not be representative of deepest tumor thickness.

Conclusion

We have demonstrated an objective measure of melanoma growth rate using sequential biopsy specimens. The correlation between faster growth and aggressive tumor features supports what others have found and validates the historical measure of growth rate as a reliable clinical marker.

Section snippets

Methods

Institutional ethics board approval was obtained, and all patients involved provided written informed consent.

The Victorian Melanoma Service (VMS) is an Australian tertiary referral, multidisciplinary treatment center for melanoma. A retrospective review of the VMS database from January 1998 to January 2013 was performed to identify all primary melanomas in which pathologic misdiagnosis on the initial partial biopsy specimen caused a delay before excisional biopsy. All cases of initial

Results

Fifty-one melanomas satisfied the inclusion criteria. This represented 1.06% of the total number of melanoma cases that were referred to the VMS during the study period. The median age at diagnosis was 52 years (range, 15-86 years), and there was a female preponderance (32 females and 19 men). There were 23 superficial spreading melanomas (SSMs), 20 lentigo malignas (LMs)/lentigo maligna melanomas (LMMs), 4 desmoplastic melanomas (DMs), 2 acral lentiginous melanomas, and 2 uncategorized

Discussion

In this study, we identified 51 cases of initial melanoma misdiagnosis on partial biopsy specimens that caused a median delay of 27 months before referral and excisional biopsy. These unfortunate occurrences provided us with a unique insight into melanoma kinetics and a more objective quantification of growth rate to compare to the patient recall–based method. Because of uncertainty of the duration of the in situ phase, we favor the objective ROG derived from tumors that were invasive at the

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Funding sources: None.

Conflicts of interest: None declared.

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