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

J Am Acad Dermatol. 2017 Jan;76(1):121-128. doi: 10.1016/j.jaad.2016.07.029. Epub 2016 Sep 28.


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.

Keywords: atypical nevi; dermatopathology; dysplastic nevi; melanocytic lesions; melanoma; melanoma in situ; treatment.

MeSH terms

  • Clinical Competence
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Liability, Legal
  • Male
  • Melanoma / pathology
  • Melanoma / therapy*
  • Middle Aged
  • Nevus, Pigmented / pathology
  • Nevus, Pigmented / therapy*
  • Pathologists / education
  • Pathologists / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Self Efficacy
  • Skin Neoplasms / pathology
  • Skin Neoplasms / therapy*
  • United States