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Video

Head and Neck Surgery

(A558) Impact of Initial Biopsy Technique on Immunotherapy Use in Melanoma

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • AM

    Andrew Mathias, BS

    Medical Student
    University of Virginia School of Medicine
    Charlottesville, Virginia, United States

    • Co-Author(s)

  • AM

    Andrew Mathias, BS

    Medical Student
    University of Virginia School of Medicine
    Charlottesville, Virginia, United States

  • Ben Aunins, MD

    Resident Physician
    University of Virginia
    Charlottesville, Virginia, United States

  • Ryan K. Stepp, BS

    Medical Student
    USC Greenville Medical School
    Greer, SC, United States

  • CO

    Connor H. O'Meara, MD, PhD, FRACS

    Head and Neck Oncology and Microvascular Reconstruction Fellow
    University of Virginia Department of Otolaryngology - Head and Neck Surgery
    Charlottesville, Virginia, United States

  • ED

    Eric Dowling, MD

    UVA Department of Otolaryngology/HNS, United States

    • Senior Author(s)

  • ED

    Eric Dowling, MD

    UVA Department of Otolaryngology/HNS, United States

Disclosure(s):
Andrew Mathias, BS: No relevant relationships to disclose.
Ben Aunins, MD: No relevant relationships to disclose.
Ryan Stepp, BS: No relevant relationships to disclose.


Introduction: Melanoma is the deadliest form of skin cancer, with global incidence projected to increase by over 50% by 2040. The choice of initial biopsy technique– shave, punch, or narrow-margin excisional– plays a crucial role in the staging and subsequent management of melanoma. This study evaluated the impact of biopsy techniques on upstaging, time-to-treatment initiation, and subsequent immunotherapy decisions.

Methods: We conducted a retrospective review of 834 patients treated for melanoma at a tertiary care hospital between 2018 and 2024. The study included 105 patients diagnosed with primary head and neck melanoma who received an initial biopsy and subsequent ENT staging. We assessed the impact of biopsy technique on the likelihood of pathological upstaging to pT3a or higher and delayed immunotherapy initiation.

Results: Among patients with upstaged pathologic grades, 21.8% of those who underwent shave biopsy were upstaged to pT3a or higher, compared to 35.7% of those who underwent punch biopsy. Patients who received a shave biopsy had an OR=3.92 of their cancer being upstaged. No upstaging occurred in patients with narrow excisional biopsies. Average time-to-treatment initiation did not significantly differ between biopsy techniques, averaging 30 days after initial biopsy. Overall, 42.9% of this cohort were found to have high-grade melanoma. Of these, 93% of the high-grade group were treated with immunotherapy, with the majority being adjuvant or salvage.

Conclusions: The findings of this study underline critical flaws in current biopsy techniques for melanoma, with both shave and punch biopsies exhibiting significant rates of upstaging that potentially delay appropriate immunotherapeutic interventions. These results underscore the need for revised biopsy protocols to ensure more accurate initial staging and facilitate timely, effective immunotherapy. Enhancing biopsy accuracy is crucial not only for improving patient outcomes, but also for optimizing treatment strategies and reducing delays in treatment.