TY - JOUR
T1 - Variation among pathologists’ treatment suggestions for melanocytic lesions
T2 - A survey of pathologists
AU - Lee, Kachiu C.
AU - Peacock, Sue
AU - Weinstock, Martin A.
AU - Zhao, Ge Alice
AU - Knezevich, Stevan R.
AU - Elder, David E.
AU - Barnhill, Raymond L.
AU - Piepkorn, Michael W.
AU - Reisch, Lisa M.
AU - Carney, Patricia A.
AU - Onega, Tracy
AU - Lott, Jason P.
AU - Elmore, Joann G.
N1 - Publisher Copyright:
© 2016 American Academy of Dermatology, Inc.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - atypical nevi
KW - dermatopathology
KW - dysplastic nevi
KW - melanocytic lesions
KW - melanoma
KW - melanoma in situ
KW - treatment
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U2 - 10.1016/j.jaad.2016.07.029
DO - 10.1016/j.jaad.2016.07.029
M3 - Article
C2 - 27692732
AN - SCOPUS:85006118751
SN - 0190-9622
VL - 76
SP - 121
EP - 128
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 1
ER -