Incisional biopsy runs the inherent risk of providing material that is not representative of the whole tumour; therefore errors may occur in assessing the depth of the tumour. One study reported that 38 of the 96 incisional biopsies on patients with cutaneous melanoma (40%) gave insufficient material to provide a full histological assessment of the lesion.12 On the other hand, excising all pigmented lesions suspected of being a MM, regardless of their site and size, could lead to inappropriate surgery in some cases. One study reported the results of a retrospective series of patients with cutaneous melanoma limited to the head and neck. A total of 159 patients were followed up for a median period of 38 months, of whom 79 patients had their lesions fully excised, 48 had an incisional biopsy, and other procedures such shave excision or cryotherapy were carried out in a further 32. Thirty-one per cent of the patients who underwent an incisional biopsy died and 25% of the other biopsy group died, compared with 9% of those who had their lesions excised initially. As this was a retrospective study, the initial surface area of the lesions was not known. There were no significant differences between the three groups in the depth of invasion of the tumours or the sex of the patients, but a significantly higher proportion of the patients in the incisional biopsy and other-procedure groups had ulcerated tumours compared with the excision group.14
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