Pearls of Wisdom: When a Biopsy Isn't Convenient
Jeremy is a 32-year-old man with a history of skin cancer in his family. At his latest exam, he mentions a dark spot on the tip of his ear that he had never paid much attention to in the past. He asks if there are any options, besides biopsy, to make sure the lesion is not cancerous.
Are there any accurate, noninvasive alternatives to biopsy?
A. No, Biopsy is the most accurate way to identify the lesion.
B. Yes, there are other, noninvasive methods that are just as accurate as biopsy.
C. No, the best method is to wait and see if the lesion changes in color, size, or shape.
What is the correct answer?
(Answer and discussion on next page)
Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. His “Pearls of Wisdom” as we like to call them, have been shared with primary care physicians annually in an educational presentation entitled 5TIWIKLY (“5 Things I Wish I Knew Last Year”…. or the grammatically correct, “5 Things I Wish I’d Known Last Year”).
Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.
Answer: Yes, there are other, noninvasive methods that are just as accurate as biopsy.
When a patients comes in for a check-up and has a lesion on their arm, the best way to determine what the lesion is is to do a biopsy. Sometimes doing a biopsy is convenient—the bump is on the back of their shoulder and they don’t care if they have a scar there—and sometimes it is inconvenient, particularly lesions on the tip of the nose, the ear, or the edge of the mouth (vermillion border). Even when surgical procedures at this sites are performed well, any marks in these places are very noticeable.
Biopsies are also expensive. We have to charge to remove the lesions and charge to send the sample out for testing. We don’t want to biopsy every bump on every patient, but without a biopsy, we can never say for certain whether a lesion is cancerous, can we?
_____________________________________________________________________________________________________________________________________________________________________
RELATED CONTENT
Skin Biopsy Techniques: When and How to Perform Punch Biopsy
Skin Biopsy Techniques: When and How to Perform Shave and Excisional Biopsy
_____________________________________________________________________________________________________________________________________________________________________
The Research
In a recent study, researchers tested the efficacy of the DermTech adhesive patch against standard biopsy at identifying pigmented lesions. The DermTech adhesive patch was applied to and removed from participants’ pigmented lesions, which were then biopsied.1
The Results
Overall, the DermTech patch correctly identified 41 of the 42 lesions that biopsy identified as melanoma (a sensitivity of 97%) and 16 of the 22 lesions that biopsy identified as nevi. However, the DermTech patch identified 6 lesions as melanoma that had been categorized as nevi by biopsy.
A Noninvasive Adhesive Patch Test for Pigmented Lesions
What’s the “Take-Home”?
These results appear to indicate that the patch overdiagnosed melanoma, but in fact, this may not be the case. After further inspection, researchers found that 3 of those 6 cases, while benign, had molecular scores consistent with a diagnosis of melanoma.
This opens up the possibility that the patch may actually be more accurate than the gold standard (biopsy) by identifying lesions that will eventually become cancerous before they have made the change.
Reference:
Gerami P, Alsobrook JP II, Palmer TJ. et al. Development of a novel noninvasive adhesive patch test for the evaluation of pigmented lesions of the skin. J Am Acad Dermatol. 2014;71:237-244