Background and Objectives. While excisional biopsy is recommended to diagnose cutaneous melanoma, various biopsy techniques are used in practice. We undertook this study to identify how frequently final tumor stage and treatment recommendations changed from diagnostic biopsy to final histopathology after wide local excision (WLE). Methods. We compared the histopathology of the dermatopathologist-reviewed diagnostic biopsy and final WLE in 332 cutaneous melanoma patients. Results. Tumor sites were extremity (51%), trunk (33%), and head/neck (16%). Initial biopsy types were excisional (56%), punch (21%), shave (18%), and incisional (5%). Most diagnostic biopsies were margin positive regardless of technique, and 36% of patients had residual melanoma on WLE. T-stage changed in 8% of patients, of whom 59% were diagnosed by punch biopsy, 15% by incisional biopsy, 15% by shave biopsy, and 11% by excisional biopsy ( ). Treatment recommendations changed in 6%: 2% after excisional biopsy, 5% after shave biopsy, 18% after punch biopsy, and 18% after incisional biopsy ( ). Conclusions. Although most biopsy margins were positive, T-stage and treatment changed for only a minority of melanoma patients. Our data provide valuable information to inform patient discussion regarding the likelihood of a change in prognosis and the need for secondary procedures after WLE. These data support the superiority of dermatopathologist-reviewed excisional biopsy when feasible. 1. Introduction The incidence of malignant melanoma continues to increase. It is estimated that more than 76,600 new cases of melanoma will be diagnosed in the United States in 2013, with 9,480 deaths attributed to this disease. The lifetime risk for the development of melanoma is now 1 in 35 for males and 1 in 54 for females [1]. The thickness of the primary melanoma, as measured histopathologically, guides treatment and provides important prognostic and staging information; a proper dermatopathologist-reviewed diagnostic biopsy is essential for appropriate management of the newly diagnosed melanoma patient. Currently, excisional biopsy is the recommended diagnostic procedure for melanoma [2–5]. However, in practice, cutaneous melanoma is diagnosed by a variety of biopsy techniques, and the proportion of cutaneous melanomas diagnosed by nonexcisional biopsy techniques is increasing [6]. Studies suggest that dedicated dermatopathology review of a pigmented lesion biopsy is important to establish a correct diagnosis [7, 8]. However, data is lacking on how the biopsy type, after dermatopathology review,
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