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

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• 作者：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 ; MScⁱ ; 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 ; ^{jelmore@uw.edu}
• 关键词：atypical nevi ; dermatopathology ; dysplastic nevi ; melanocytic lesions ; melanoma ; melanoma in situ ; treatment
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：76
• 期：1
• 页码：121-128
• 全文大小：409 K
• 卷排序：76

文摘

The extent of variability in treatment suggestions for melanocytic lesions made by pathologists is unknown.ObjectiveWe investigated how often pathologists rendered suggestions, reasons for providing suggestions, and concordance with national guidelines.MethodsWe conducted a cross-sectional survey of pathologists. Data included physician characteristics, experience, and treatment recommendation practices.ResultsOf 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.LimitationsTreatment suggestions were self-reported.ConclusionsPathologists made recommendations ranging in consistency. These findings may inform efforts to reduce treatment variability and optimize patterns of care delivery for patients.