Pathologists’ treatment suggestions vary significantly for melanocytic lesions
December 26, 2019
Abstract
Background: While treatment guidelines exist for melanoma in situ and invasive melanoma, guidelines for other melanocytic skin lesions do not exist.
Objective: To examine pathologists’ treatment suggestions for a broad spectrum of melanocytic skin lesions and in comparison with existing guidelines.
Methods: Pathologists (N=187) completed a survey and then provided diagnoses and treatment suggestions for 240 melanocytic skin lesions. Physician characteristics associated with treatment suggestions were evaluated using multivariable modeling.
Results: Treatment suggestions were concordant with National Comprehensive Cancer Network (NCCN) guidelines for the majority of cases interpreted as melanoma in situ (73%) and invasive melanoma (86%). Greater variability of treatment suggestions was seen for other lesion types without existing treatment guidelines. Characteristics associated with provision of treatment suggestions discordant with NCCN guidelines were: low caseloads (invasive melanoma), lack of fellowship training or board certification (melanoma in situ), and >10 years of experience (invasive melanoma and melanoma in situ).
Limitations: Pathologists could not perform immunohistochemical staining or other diagnostic tests; only one glass side provided per biopsy case.
Conclusions: Pathologists’ treatment suggestions vary significantly for melanocytic lesions, with lower variability for lesion types with national guidelines. Results suggest the need for standardization of treatment guidelines for all melanocytic lesion types.
Source:
Mustufa A. Jafry, Sue Peacock, Andrea C. Radick, Hannah L. Shucard, Lisa M. Reisch, Michael W. Piepkorn, Stevan R. Knezevich, Martin A. Weinstock, Raymond L. Barnhill, David E. Elder, Kathleen F. Kerr, Joann G. Elmore, Pathologists’ Agreement on Treatment Suggestions for Melanocytic Skin Lesions, Journal of the American Academy of Dermatology, 2019, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2019.12.020.