Completeness of Histopathology Reporting of Melanoma in a High-Incidence Geographical Region

Abstract

Background: Appropriate histopathology reporting helps to ensure effective therapy and prognosis. Objective: Toexamine compliance with clinical practice guidelines for histopathology reports of melanomas. Methods: A sample of melanoma histopathology reports in Queensland was audited for inclusion of recommended information. The quality of documentation was constructed and multivariate analysis used to determine factors affecting the quality of reporting practices. Results: Documentation of the most important features of melanoma was high: clear diagnosis (99.8%; 95% CI 98.6–100), thickness (99.8%; 95% CI 98.6–100), comment on adequacy of excision (87.9%; 95% CI 84.9–91.0) and measurement of margins (91.9%; 95% CI 88.8–91.4). Overall reporting of ulceration and regression was of lesser completeness (83.0 and 77.8%, respectively) and these features were more likely to be reported by high-volume laboratories (p < 0.001 and p = 0.037, respectively). This trend was not apparent for other features. Fewer than 50% of reports documented mitotic rate per square millimetre, predominant cell type, microsatellites, growth phase and desmoplasia. Conclusion: Awareness of current reporting practices and identification of areas in which insufficiencies exist enable the revision of systems and potential improvements to the transfer of information to treating clinicians.

GPs’ involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study

“…Previous research has explored various aspects of melanoma care in the Australian setting, 14,[16][17][18][19][20][21][22] including compliance with clinical practice guidelines, 15,[23][24][25][26][27] but not how GPs understand their multiple potential roles within melanoma patient care. The aim of the current study was to identify factors that affect GPs' confidence in, and attitudes towards, managing patients with suspected or confirmed melanoma, and how GPs explain their decisions to biopsy, treat, or refer.…”

Agreement of Dermatopathologists in the Evaluation of Clinically Difficult Melanocytic Lesions: How Golden Is the ‘Gold Standard’?

“…In addition, the final pathology diagnosis, whether correct or not, is ultimately responsible for determining which lesions enter into cancer registry databases [1]. This in turn may influence the results of epidemiological investigations of cancer, diagnostic studies, or comparative studies that rely upon evaluations provided by pathologists [2,3,4,5].…”

Impact of the 2009 AJCC staging guidelines for melanoma on the number of mitotic figures reported by dermatopathologists at one institution

“…Using multivariate analysis, it was shown that one or more dermal mitoses per millimeter squared in thin melanomas was significantly associated with decreased survival . A limitation of this study and others is the lack of mitotic counts in a large proportion of the reports collected . A recent report suggested that a mitotic rate of three or more was correlated with clinical outcome, but another report focusing on thin melanomas (<1.0 mm in depth) failed to find a relationship between mitotic rate and sentinel lymph node status .…”

“…2 A limitation of this study and others is the lack of mitotic counts in a large proportion of the reports collected. 3,4 A recent report suggested that a mitotic rate of three or more was correlated with clinical outcome, 5 but another report focusing on thin melanomas (<1.0 mm in depth) failed to find a relationship between mitotic rate and sentinel lymph node status. 6 Nonetheless, one mitosis is still currently sufficient to upstage a patient with a thin (≤1.0 mm) non-ulcerated melanoma to T1b.…”