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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2014

01-07-2014 | Melanomas

Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center

Authors: Maarten G. Niebling, MD, PhD, Lauren E. Haydu, BSCHE, MIPH, Rooshdiya Z. Karim, MBBS, PhD, FRCPA, John F. Thompson, MD, FRACS, FACS, Richard A. Scolyer, MD, FRCPA, FRCPath

Published in: Annals of Surgical Oncology | Issue 7/2014

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Abstract

Background

Pathologists sometimes disagree on the diagnosis of melanoma or its histopathologic staging, which may have implications for treatment and follow-up. For this reason, melanoma patients referred to Melanoma Institute Australia (MIA) for further treatment routinely have their pathology slides reviewed by MIA pathologists. This study sought to determine whether diagnosis, staging, and treatment of melanoma patients changed significantly after central pathology review.

Methods

A total of 5,011 pairs of non-MIA and MIA pathology reports on the same primary melanoma specimen were reviewed. Differences in diagnosis, American Joint Committee on Cancer (AJCC) T classification, and treatment recommendations based on the non-MIA and MIA pathology reports were determined.

Results

A melanoma diagnosis changed in 5.1 % of cases after review. Where both pathologists agreed on a diagnosis of melanoma, AJCC T classification changed in 22.1 % after review. After MIA review, planned surgical excision margins changed in 11.2 % of cases, and a recommendation for sentinel lymph node biopsy (SLNB) changed in 8.6 %. Non-MIA reports less frequently contained criteria to define AJCC T classification (86.6 vs. 97.6 %), select appropriate surgical excision margins (95.2 vs. 99.6 %) and make a recommendation for SLNB (94.5 vs. 99.4 %), (each p < 0.001). On multivariate analysis, partial biopsies were independently associated with more frequent changes in AJCC T classification (p < 0.001), planned surgical excision margins (p < 0.001), and SLNB recommendations (p < 0.001) on the basis of MIA pathology review.

Conclusions

Diagnosis, AJCC T classification, and treatment recommendations often change after pathology review by specialist melanoma pathologists. We recommend pathology review be considered for all patients attending specialist melanoma treatment centers.
Appendix
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Metadata
Title
Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center
Authors
Maarten G. Niebling, MD, PhD
Lauren E. Haydu, BSCHE, MIPH
Rooshdiya Z. Karim, MBBS, PhD, FRCPA
John F. Thompson, MD, FRACS, FACS
Richard A. Scolyer, MD, FRCPA, FRCPath
Publication date
01-07-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 7/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3682-x

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