Pathologists' agreement on treatment suggestions for melanocytic skin lesions - 10/03/20

Doi : 10.1016/j.jaad.2019.12.020

Mustufa A. Jafry, BA, BA ^a, Sue Peacock, MS ^a, Andrea C. Radick, MS ^a, Hannah L. Shucard, MS ^a, Lisa M. Reisch, PhD ^a, Michael W. Piepkorn, MD, PhD ^b,^c, Stevan R. Knezevich, MD, PhD ^d, Martin A. Weinstock, MD, PhD ^e,^f, Raymond L. Barnhill, MD ^g, David E. Elder, MBChB, FRCPA ^h, Kathleen F. Kerr, PhD ⁱ, Joann G. Elmore, MPH, MD ^a,^j,^⁎
^a Department of Medicine, University of Washington School of Medicine, Seattle, Washington
^b Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
^c Dermatopathology Northwest, Bellevue, Washington
^d Pathology Associates, Clovis, California
^e Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island
^f Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
^g Department of Pathology, Institut Curie, Paris Sciences and Lettres Research University; Faculty of Medicine, University of Paris Descartes, Paris, France
^h Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
ⁱ Department of Biostatistics, University of Washington, Seattle, Washington
^j Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California

^∗Correspondence to: Joann G. Elmore, MPH, MD, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave, Ste 900, Los Angeles, CA 90024.Department of MedicineDavid Geffen School of MedicineUniversity of California, Los Angeles1100 Glendon Ave, Ste 900Los AngelesCA90024

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 10 March 2020

Abstract

Background

Although 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 compare them 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 with multivariable modeling.

Results

Treatment suggestions were concordant with National Comprehensive Cancer Network 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 National Comprehensive Cancer Network guidelines were low caseloads (invasive melanoma), lack of fellowship training or board certification (melanoma in situ), and more than 10 years of experience (invasive melanoma and melanoma in situ).

Limitations

Pathologists could not perform immunohistochemical staining or other diagnostic tests; only 1 glass side was 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.

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Key words : invasive melanoma, melanocytic skin lesions, melanoma in situ, pathology, skin biopsies, treatment guidelines

Abbreviations used : MPATH-Dx, MSL, NCCN

Plan

Methods

Identification, recruitment, and baseline characteristics of study pathologists

Case selection and composition

Case interpretation by pathologists

Statistical analysis

Results

Discussion

Strengths and limitations

Clinical and policy implications

Conclusion

	Funding sources: Supported by the National Cancer Institute (R01 CA151306, R01 CA 200690, R01 CA201376) and the University of Washington Medical Student Research Training Program. The funding agency had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
	Conflicts of interest: None disclosed.
	Parts of the data and analyses included in this study were presented at the Western Medical Research Conference, January 25-27, 2018, Carmel, CA, and the American Society of Dermatopathology Annual Meeting, November 8-11, 2018, Chicago, IL.
	IRB approval status: Reviewed and approved by the University of Washington IRB (# 44309).
	Reprints not available from the authors.