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Do Pathologists Offer Consistent Treatment Advice for Melanoma?

Pathologists provide the definitive diagnosis of melanocytic lesions, but do they offer treatment suggestions with their diagnoses?

Because there is a lack of consensus for both diagnosis and treatment of various types of atypical dysplastic nevi, pathologists may be in a unique position to offer suggestions for treatment. For example, lesions with the same diagnosis, such as Spitz nevi, can vary in pathologic characteristics and pathologists may be in a position to better guide treatment for these lesions. A recent study surveyed about 300 pathologists to determine how often and why practicing pathologists offer treatment suggestions in their final pathology reports, what suggestions are provided, and whether the suggestions align with NCCN guidelines for melanoma treatment.

The results showed that pathologists infrequently included treatment suggestions in final pathology reports. About 15% never included suggestions while about 7% always included recommendations. For the rest of the pathologists surveyed, the decision of when to give suggestions varied. The pathologists that gave suggestions did so for reasons that included: improved patient care, clarification of treatment options for the biopsying clinician, and protection from legal liability. Those that opted not to include them did so because: referring physicians did not want recommendations in the pathology report, there was insufficient clinical information, or the pathologist lacked requisite clinical expertise. Pathologists who were board certified or fellowship trained in dermatopathology, or who had a higher melanocytic lesion caseload were significantly more likely to include suggestions.

The authors note that this study highlights the wide range of treatment suggestions for melanocytic lesions and attribute that variation to the lack of national treatment guidelines. The pathologists that had greater experience and dermatopathology training tended to make more conservative treatment suggestions for mild and moderately dysplastic nevi. The recommendations for treating melanomas and melanoma in situ tended to be consistent with established NCCN guidelines. But, the authors point out that some pathologists made recommendations that would have undertreated or overtreated these melanocytic lesions. The authors conclude that the results may reflect uncertainty in the evidence-based literature regarding treatment of these lesions; the findings point to a potential gap in use of treatment guidelines and underscore the challenge that clinicians face with the intermediate melanocytic lesions.

 

Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: February 6, 2017

Source: JAAD
Adapted from the original article.

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