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


CONCLUSIONS
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.
Department of Dermatology, Brown University, Providence, Rhode Island.
Kachiu C
KC
Lee
Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Sue
S
Peacock
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.
Martin A
MA
Weinstock
Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Ge Alice
GA
Zhao
Pathology Associates, Clovis, California.
Stevan R
SR
Knezevich
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
David E
DE
Elder
Departments of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France.
Raymond L
RL
Barnhill
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.
Michael W
MW
Piepkorn
Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
Lisa M
LM
Reisch
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Patricia A
PA
Carney
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.
Tracy
T
Onega
Cornell Scott-Hill Health Center, New Haven, Connecticut.
Jason P
JP
Lott
Department of Medicine, University of Washington School of Medicine, Seattle, Washington. Electronic address: jelmore@uw.edu.
Joann G
JG
Elmore
D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology / Q000628:therapy*; D000072142:Pathologists / Q000193:education / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D014481:United States
atypical nevi; dermatopathology; dysplastic nevi; melanocytic lesions; melanoma; melanoma in situ; treatment
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