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

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

Supported in part by the Australian National Health and Medical Research Council and Cancer Institute, New South Wales. RAS was supported by the Cancer Institute New South Wales and NHMRC Fellowship programs. The authors gratefully acknowledge the assistance and support of their colleagues at Melanoma Institute Australia and the Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Melanoma Institute Australia, Sydney, NSW, Australia

    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

  2. Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Lauren E. Haydu BSCHE, MIPH & John F. Thompson MD, FRACS, FACS

  3. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Rooshdiya Z. Karim MBBS, PhD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  4. Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Rooshdiya Z. Karim MBBS, PhD, FRCPA & Richard A. Scolyer MD, FRCPA, FRCPath

  5. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    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

Authors
  1. Maarten G. Niebling MD, PhD
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  2. Lauren E. Haydu BSCHE, MIPH
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  3. Rooshdiya Z. Karim MBBS, PhD, FRCPA
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  4. John F. Thompson MD, FRACS, FACS
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  5. Richard A. Scolyer MD, FRCPA, FRCPath
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Corresponding author

Correspondence to Richard A. Scolyer MD, FRCPA, FRCPath.

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Niebling, M.G., Haydu, L.E., Karim, R.Z. et al. Pathology Review Significantly Affects Diagnosis and Treatment of Melanoma Patients: An Analysis of 5011 Patients Treated at a Melanoma Treatment Center. Ann Surg Oncol 21, 2245–2251 (2014). https://doi.org/10.1245/s10434-014-3682-x

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  • DOI: https://doi.org/10.1245/s10434-014-3682-x

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