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Journal of the American Academy of Dermatology

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Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists - 18/04/17

Doi : 10.1016/j.jaad.2016.07.029 
Kachiu C. Lee, MD a, Sue Peacock, MSc f, Martin A. Weinstock, MD, PhD a, b, c, d, Ge Alice Zhao, MD, PhD e, f, Stevan R. Knezevich, MD, PhD g, David E. Elder, MB ChB, FRCPA h, Raymond L. Barnhill, MD, MSc i, Michael W. Piepkorn, MD, PhD e, f, j, Lisa M. Reisch, PhD f, Patricia A. Carney, PhD k, Tracy Onega, PhD l, Jason P. Lott, MD, MHS, MSHP m, Joann G. Elmore, MD, MPH f, ⁎
a Department of Dermatology, Brown University, Providence, Rhode Island 
b Department of Epidemiology, Brown University, Providence, Rhode Island 
c Dermatoepidemiology Unit, Department of Veterans Affairs Medical Center, Providence, Rhode Island 
d Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island 
e Division of Dermatology, University of Washington School of Medicine, Seattle, Washington 
f Department of Medicine, University of Washington School of Medicine, Seattle, Washington 
g Pathology Associates, Clovis, California 
h Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 
i Departments of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France 
j Dermatopathology Northwest, Bellevue, Washington 
k Department of Family Medicine, Oregon Health & Science University, Portland, Oregon 
l Departments of Biomedical Data Science and Epidemiology, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire 
m Cornell Scott-Hill Health Center, New Haven, Connecticut 

∗Correspondence to: Joann G. Elmore, MD, MPH, Department of Medicine, University of Washington School of Medicine, 325 9th Ave, Box 359780, Seattle, WA 98104.Department of MedicineUniversity of Washington School of Medicine325 9th Ave, Box 359780SeattleWA98104

Abstract

Background

The extent of variability in treatment suggestions for melanocytic lesions made by pathologists is unknown.

Objective

We investigated how often pathologists rendered suggestions, reasons for providing suggestions, and concordance with national guidelines.

Methods

We conducted a cross-sectional survey of pathologists. Data included physician characteristics, experience, and treatment recommendation practices.

Results

Of 301 pathologists, 207 (69%) from 10 states (California, Connecticut, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, and Washington) enrolled. In all, 15% and 7% reported never and always including suggestions, respectively. Reasons for offering suggestions included improved care (79%), clarification (68%), and legal liability (39%). Reasons for not offering suggestions included referring physician preference (48%), lack of clinical information (44%), and expertise (29%). Training and caseload were associated with offering suggestions (P < .05). Physician suggestions were most consistent for mild/moderate dysplastic nevi and melanoma. For melanoma in situ, 18 (9%) and 32 (15%) pathologists made suggestions that undertreated or overtreated lesions based on National Comprehensive Cancer Network (NCCN) guidelines, respectively. For invasive melanoma, 14 (7%) pathologists made treatment suggestions that undertreated lesions based on NCCN guidelines.

Limitations

Treatment suggestions were self-reported.

Conclusions

Pathologists made recommendations ranging in consistency. These findings may inform efforts to reduce treatment variability and optimize patterns of care delivery for patients.

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Key words : atypical nevi, dermatopathology, dysplastic nevi, melanocytic lesions, melanoma, melanoma in situ, treatment

Abbreviations used : M-Path, MPATH-Dx, NCCN


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 Supported by the National Cancer Institute (R01 CA151306, KO5 CA104699). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.
 Disclosure: Dr Lott is an employee of Bayer HealthCare Pharmaceuticals, which had no involvement in this research. Drs Lee, Weinstock, Zhao, Knezevich, Elder, Barnhill, Piepkorn, Reisch, Carney, Onega, and Elmore, and Ms Peacock have no conflicts of interest to declare.
 Reprints will not be available from the authors.


© 2016  American Academy of Dermatology, Inc.. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 76 - N° 1

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