The authors thank Brown et al. for their comments, and agree with their interpretation and conclusions.
1 It was unsettling that our systematic review disclosed an overall relatively high base transection rate with shave biopsy (42%). Furthermore, as noted in our review, and also by other authors, the rate of deep margin positivity following shave biopsy increased with increasing Breslow thickness.
2,
3 Understandably, incomplete sampling has represented one of the reasons that surgical oncologists have traditionally objected to shave biopsy in the setting of pigmented lesions, given that Breslow thickness is known to factor heavily into melanoma prognostication and management algorithms. However, we were equally surprised, but reassured, that base transection translated into relatively small, reported changes to tumor stage or treatment recommendations (7.7 and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed. We presume this is because, overall, shaves are capable of at least diagnosing most invasive and T1b melanomas, and therefore at least adequately stratifying patients requiring prognostically relevant locoregional management, such as wider excision and sentinel node biopsy. …
