Influence of biopsy on the prognosis of cutaneous melanoma of the head and neck

This study was performed to determine the effect of biopsy type on survival rates and on local, regional, and distant metastasis in patients with head and neck cutaneous melanoma. Methods. A case series of 159 patients with melanoma of the head and neck referred to a tertiary-care center between 1983 and 1991, with a median follow-up of 38 months, was reviewed. Information analyzed included patient's age, sex, type of treatment, mode of biopsy, presence of residual melanoma in re-excision, location of lesion, presence of ulceration, Clark's level, Breslow thickness, and histologic type of the melanoma. Results. Excisional biopsy was performed in 79 patients, incisional biopsy in 48, and other procedures (shave, needle biopsy, cauterization, or cryotherapy) in 32. There were no significant pretreatment differences among the three groups in sex, thickness, histologic type, presence of nodal disease, or type of treatment. Pretreatment location of lesion was significantly different (p =.03) between the excisional and other biopsy types. Association between type of biopsy and survival rate was significant (p <.001): 31.3% of patients in the incisional biopsy group died of disease, as did 25% of the other biopsy group, versus 8.9% of the excisional biopsy group; 31.3% of patients in the incisional biopsy group developed distant metastases, as did 28.1% of the other biopsy type, versus 10.1% of those in the excisional biopsy group (p =.01). There was no significant difference in local p =.37) or regional (p = 1.00) recurrence among the three biopsy groups. Multivariate analysis showed presence of tumor in the re-excision specimen, biopsy type, and nodal disease to be independent prognostic factors.