The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

To the Editor: De Menezes and colleagues1 report increasing use of shave biopsy for melanoma diagnosis in association with significant rates of base transection. They cite a wide range of base transection rates in the literature (7–68%), giving pause for thought: what is at play here besides the shave biopsy itself? This is an important question, as the incidence of invasive melanoma rose significantly over the study period along with a doubling of the frequency of shave biopsy. Particularly in Queensland, dubiously honoured with the title of “melanoma capital of the world,” we must be cautious about dismissing this efficient and low cost procedure.

De Menezes and colleagues1 could not assess clinician intent regarding biopsy depth, and we do not know whether melanoma was the provisional diagnosis. There is an important distinction between superficial shave biopsies and saucerisation, which is acknowledged but not examined. Saucerisation would be expected to produce lower rates of base transection and tumour upstaging.

The authors have not stratified the base transection rate by year. It would be useful to know whether better education, increasing use of dermoscopy and improved shave tools have influenced base transection over the 10‐year period.

What is the standard of care for evaluating potential melanomas? Should more excisional biopsies be performed to increase microstaging accuracy when base transection has not been proven to reduce survival? We agree that excisional biopsy is the best way to evaluate a highly suspicious lesion. However, the role of the shave biopsy must be defended, particularly in patients with many lesions, in older and relatively immobile patients, and in rural populations. De Menezes and colleagues1 acknowledge the benefits of shave biopsy in terms of cost and reduced risk of missed or delayed diagnosis when the index of suspicion is low. Better training and improved shave equipment are the keys to ensuring better results.