Mustufa A Jafry1, Sue Peacock1, Andrea C Radick1, Hannah L Shucard1, Lisa M Reisch1, Michael W Piepkorn2, Stevan R Knezevich3, Martin A Weinstock4, Raymond L Barnhill5, David E Elder6, Kathleen F Kerr7, Joann G Elmore8. 1. Department of Medicine, University of Washington School of Medicine, Seattle, Washington. 2. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington. 3. Pathology Associates, Clovis, California. 4. Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island. 5. Department of Pathology, Institut Curie, Paris Sciences and Lettres Research University; Faculty of Medicine, University of Paris Descartes, Paris, France. 6. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 7. Department of Biostatistics, University of Washington, Seattle, Washington. 8. Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California. Electronic address: jelmore@mednet.ucla.edu.
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.
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.
Authors: Tracy Onega; Lisa M Reisch; Paul D Frederick; Berta M Geller; Heidi D Nelson; Jason P Lott; Andrea C Radick; David E Elder; Raymond L Barnhill; Michael W Piepkorn; Joann G Elmore Journal: J Digit Imaging Date: 2016-04 Impact factor: 4.056
Authors: Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan R Knezevich; Patricia A Carney; Lisa M Reisch; Joann G Elmore Journal: J Am Acad Dermatol Date: 2013-10-28 Impact factor: 11.527
Authors: Pedram Gerami; Klaus Busam; Alistair Cochran; Martin G Cook; Lyn M Duncan; David E Elder; Douglas R Fullen; Joan Guitart; Philip E LeBoit; Martin C Mihm; Victor G Prieto; Michael S Rabkin; Richard A Scolyer; Xiaowei Xu; Sook Jung Yun; Roxana Obregon; Pedram Yazdan; Chelsea Cooper; Bing Bing Weitner; Alfred Rademaker; Raymond L Barnhill Journal: Am J Surg Pathol Date: 2014-07 Impact factor: 6.394
Authors: Caroline C Kim; Susan M Swetter; Clara Curiel-Lewandrowski; James M Grichnik; Douglas Grossman; Allan C Halpern; John M Kirkwood; Sancy A Leachman; Ashfaq A Marghoob; Michael E Ming; Kelly C Nelson; Emir Veledar; Suraj S Venna; Suephy C Chen Journal: JAMA Dermatol Date: 2015-02 Impact factor: 10.282
Authors: R L Barnhill; Z B Argenyi; L From; L F Glass; J C Maize; M C Mihm; M S Rabkin; S G Ronan; W L White; M Piepkorn Journal: Hum Pathol Date: 1999-05 Impact factor: 3.466
Authors: Kachiu C Lee; Sue Peacock; Martin A Weinstock; Ge Alice Zhao; Stevan R Knezevich; David E Elder; Raymond L Barnhill; Michael W Piepkorn; Lisa M Reisch; Patricia A Carney; Tracy Onega; Jason P Lott; Joann G Elmore Journal: J Am Acad Dermatol Date: 2016-09-28 Impact factor: 11.527
Authors: R Corona; A Mele; M Amini; G De Rosa; G Coppola; P Piccardi; M Fucci; P Pasquini; T Faraggiana Journal: J Clin Oncol Date: 1996-04 Impact factor: 44.544
Authors: Jason P Lott; Joann G Elmore; Ge A Zhao; Stevan R Knezevich; Paul D Frederick; Lisa M Reisch; Emily Y Chu; Martin G Cook; Lyn M Duncan; Rosalie Elenitsas; Pedram Gerami; Gilles Landman; Lori Lowe; Jane L Messina; Martin C Mihm; Joost J van den Oord; Michael S Rabkin; Birgitta Schmidt; Christopher R Shea; Sook Jung Yun; George X Xu; Michael W Piepkorn; David E Elder; Raymond L Barnhill Journal: J Am Acad Dermatol Date: 2016-05-14 Impact factor: 11.527
Authors: L J Meyer; M Piepkorn; D E Goldgar; C M Lewis; L A Cannon-Albright; J J Zone; M H Skolnick Journal: J Am Acad Dermatol Date: 1996-04 Impact factor: 11.527