Prognostic Factors in Cutaneous Melanoma

Piepkorn, Michael; Barnhill, Raymond L.

doi:10.1007/978-3-642-38385-4_14

Cited by 3 publications

(2 citation statements)

References 262 publications

(163 reference statements)

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“…( 19 ) Consistent with this concern, some studies have shown a worse outcome for patients with regressed tumors (reviewed in Piepkorn & Barnhill, 2014). ( 20 ) Other studies, however, have indicated that tumor regression predicts better outcome, while still others have shown no association (reviewed in Piepkorn & Barnhill, 2014). ( 20 ) A recent meta-analysis of 14 studies,( 10 ) published after our study was underway, noted a strong, inverse association between tumor regression and lymph node metastasis, implying more favorable survival, but heterogeneity was substantial among the analyzed studies.…”

Section: Discussionmentioning

confidence: 99%

“…( 20 ) Other studies, however, have indicated that tumor regression predicts better outcome, while still others have shown no association (reviewed in Piepkorn & Barnhill, 2014). ( 20 ) A recent meta-analysis of 14 studies,( 10 ) published after our study was underway, noted a strong, inverse association between tumor regression and lymph node metastasis, implying more favorable survival, but heterogeneity was substantial among the analyzed studies. ( 10 ) It should also be noted that nearly half of melanomas disseminate without first invading the regional lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

Titus

Barnhill

Lott

et al. 2017

Laboratory Investigation

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It is not known whether patient age or tumor characteristics such as tumor regression or solar elastosis influence pathologists’ interpretation of melanocytic skin lesions. We undertook a study to determine the influence of these factors, and to explore pathologist characteristics associated with the direction of diagnosis. To meet our objective, we designed a cross-sectional survey study of pathologists’ clinical practices and perceptions. Pathologists were recruited from diverse practices in ten states in the U.S. We enrolled 207 pathologist participants whose practice included the interpretation of melanocytic skin lesions.Our findings indicated that the majority of pathologists (54.6%) were influenced toward a less severe diagnosis when patients were <30 years of age. Most pathologists were influenced toward a more severe diagnosis when patients were >70 years of age, or by the presence of tumor regression or solar elastosis (58.6%, 71.0%, 57.0%, respectively). Generally, pathologists with dermatopathology board certification and/or a high caseload of melanocytic skin lesions were more likely to be influenced, while those with more years’ experience interpreting MSL were less likely to be influenced. Our findings indicate that the interpretation of melanocytic skin lesions is influenced by patient age, tumor regression, and solar elastosis; such influence is associated with dermatopathology training and higher caseload, consistent with expertise and an appreciation of lesion complexity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

Titus

Barnhill

Lott

et al. 2017

Laboratory Investigation

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Role of epithelial–mesenchymal transition involved molecules in the progression of cutaneous melanoma

Murtas

Maxia

Diana

et al. 2017

Histochem Cell Biol

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Malpractice and Patient Safety Concerns

Reisch

Flores

Radick

et al. 2020

American Journal of Clinical Pathology

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Abstract Objectives “Assurance behaviors,” a type of defensive medicine, involve physicians’ utilization of additional patient services to avoid adverse legal outcomes. We aim to compare the use of clinical behaviors (such as ordering additional tests, services, and consultations) due to malpractice concerns with the same behaviors due to patient safety concerns. Methods A national sample of dermatopathologists (n = 160) completed an online survey. Results Participants reported using one or more of five clinical behaviors due to concerns about medical malpractice (95%) and patient safety (99%). Self-reported use of clinical behaviors due to malpractice concerns and patient safety concerns was compared, including ordering additional immunohistochemistry/molecular tests (71% vs 90%, respectively, P < .0001), recommending additional surgical sampling (78% vs 91%, P < .0001), requesting additional slides (81% vs 95%, P < .0001), obtaining second reviews (78% vs 91%, P < .0001), and adding caveats into reports regarding lesion difficulty (85% vs 89%, P > .05). Conclusions Dermatopathologists use many clinical behaviors both as assurance behaviors and due to patient safety concerns, with a higher proportion reporting patient safety concerns as a motivation for specific behaviors.

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Prognostic Factors in Cutaneous Melanoma

Cited by 3 publications

References 262 publications

The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions

Role of epithelial–mesenchymal transition involved molecules in the progression of cutaneous melanoma

Malpractice and Patient Safety Concerns

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