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

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

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)121-128
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume76
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • atypical nevi
  • dermatopathology
  • dysplastic nevi
  • melanocytic lesions
  • melanoma
  • melanoma in situ
  • treatment

ASJC Scopus subject areas

  • Dermatology

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    Lee, K. C., Peacock, S., Weinstock, M. A., Zhao, G. A., Knezevich, S. R., Elder, D. E., Barnhill, R. L., Piepkorn, M. W., Reisch, L. M., Carney, P. A., Onega, T., Lott, J. P., & Elmore, J. G. (2017). Variation among pathologists’ treatment suggestions for melanocytic lesions: A survey of pathologists. Journal of the American Academy of Dermatology, 76(1), 121-128. https://doi.org/10.1016/j.jaad.2016.07.029