Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan;76(1):121-128.
doi: 10.1016/j.jaad.2016.07.029. Epub 2016 Sep 28.

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

Kachiu C Lee  1 , Sue Peacock  2 , Martin A Weinstock  3 , Ge Alice Zhao  4 , Stevan R Knezevich  5 , David E Elder  6 , Raymond L Barnhill  7 , Michael W Piepkorn  8 , Lisa M Reisch  2 , Patricia A Carney  9 , Tracy Onega  10 , Jason P Lott  11 , Joann G Elmore  12
Affiliations

Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists

Kachiu C Lee et al. J Am Acad Dermatol. 2017 Jan.

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.

Keywords: atypical nevi; dermatopathology; dysplastic nevi; melanocytic lesions; melanoma; melanoma in situ; treatment.

PubMed Disclaimer

Conflict of interest statement

Dr. Lott is an employee of Bayer HealthCare Pharmaceuticals, which had no involvement in this research.

Figures

Figure 1
Figure 1
Treatment suggestions of practicing U.S. pathologists based on type of melanocytic lesion (categories 1 through 5 refer to categories of the MPATH-Dx schema).
See this image and copyright information in PMC

References

    1. Barnhill RL, Argenyi ZB, From L, et al. Atypical Spitz nevi/tumors: lack of consensus for diagnosis, discrimination from melanoma, and prediction of outcome. Hum Pathol. 1999;30:513–20. - PubMed
    1. Su LD, Fullen DR, Sondak VK, Johnson TM, Lowe L. Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions: a report on 18 patients. Cancer. 2003;97:499–507. - PubMed
    1. Chen S. The dysplastic nevus controversy: It is not about the nevus per se but one’s belief in the multistep tumorigenesis theory. Am J Dermatopathol. 2010;32:858. - PubMed
    1. NIH Consensus conference. Diagnosis and treatment of early melanoma. JAMA. 1992;268:1314–9. - PubMed
    1. Diagnosis and treatment of early melanoma. NIH Consensus Development Conference January 27–29, 1992 Consensus statement / NIH Consensus Development Conference National Institutes of Health Consensus Development Conference; 1992; pp. 1–25. - PubMed

MeSH terms