Number of levels required to assess Breslow thickness in cutaneous invasive melanoma: An Observational Study
Dr Jamie Bishop MBChB  Dr Ben Tallon MBChB
First published: 03 July 2019 https://doi.org/10.1111/cup.13541
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/cup.13541.
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Abstract
Background
Melanoma is a globally significant and highly prevalent disease, with Breslow thickness widely recognized as the most important histologic indicator of prognosis. In the newest edition of the AJCC Cancer Staging Manual, changes have been made to the definition of stages based on Breslow thickness. It is therefore imperative we accurately measure the Breslow thickness in a standardized fashion.

Methods
Our study aimed to identify the optimum number of levels required to measure Breslow thickness. We reviewed archived cases of previously diagnosed invasive melanomas and assessed whether there was a change of T stage with the greater number of levels examined.

Results
In our series of 54 cases, ten (18.5%) cases were upgraded as additional levels were examined, statistically significant at the threshold of three levels.

Conclusions
Our data suggests the optimum number of levels to examine is three, with no benefit seen in further levels up to ten.