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Clarke LE, Hosler GA. A standardized approach to classifying melanocytic neoplasms? Comments on the MPATH-Dx system. J Cutan Pathol 2021; 48:730-732. [PMID: 33617000 DOI: 10.1111/cup.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
The potential benefits and limitations of the MPATH-Dx classification system for melanocytic neoplasms are presented and discussed.
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Affiliation(s)
- Loren E Clarke
- Dermatology Unit, Myriad Genetics, Salt Lake City, Utah, USA
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Lee KC, Peacock S, Weinstock MA, Zhao GA, Knezevich SR, Elder DE, Barnhill RL, Piepkorn MW, Reisch LM, Carney PA, Onega T, Lott JP, Elmore JG. Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists. J Am Acad Dermatol 2016; 76:121-128. [PMID: 27692732 DOI: 10.1016/j.jaad.2016.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 01/06/2023]
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.
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Affiliation(s)
- Kachiu C Lee
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Martin A Weinstock
- Department of Dermatology, Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University, Providence, Rhode Island; Dermatoepidemiology Unit, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island
| | - Ge Alice Zhao
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond L Barnhill
- Departments of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France
| | - Michael W Piepkorn
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington
| | - Lisa M Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tracy Onega
- Departments of Biomedical Data Science and Epidemiology, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jason P Lott
- Cornell Scott-Hill Health Center, New Haven, Connecticut
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
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