Reporting of mitotic rate in cutaneous melanoma: A study using the national cancer data base

Abstract

MR reporting increased dramatically after the introduction of AJCC7; however, disparities in reporting remain across facility types. Further investigation of procedures performed in academic settings that may influence reporting of MR is warranted. J. Surg. Oncol. 2017;115:281-286. © 2017 Wiley Periodicals, Inc.

The importance of mitotic rate reporting in primary cutaneous melanoma

“…Primary melanoma (M) mitotic rate (MR) is considered to be an important adverse predictor for overall survival: as the number of mitoses/mm 2 increases, survival decreases . In multivariate analyses, MR was found to be the second powerful predictor of survival outcome, after Breslow's thickness, in patients with localized M .…”

“…The 2009 Committee, in fact, concluded that the histologic diagnosis of all primary Ms should include a MR determination, using a standardized approach, the so‐called “hot spot” method . In this regard, Lorimer et al have examined 107 194 patients affected by M from 2010 to 2013; MR was reported in only 80 039 cases (74.7%). According to the Authors, for the remaining 27 155 patients, the lack of MR reporting can have important implications for proper staging and prognostication, arguing that with detailed pathological reports, clinicians may formulate more personalized and effective treatment plans .…”

“…In this regard, Lorimer et al have examined 107 194 patients affected by M from 2010 to 2013; MR was reported in only 80 039 cases (74.7%). According to the Authors, for the remaining 27 155 patients, the lack of MR reporting can have important implications for proper staging and prognostication, arguing that with detailed pathological reports, clinicians may formulate more personalized and effective treatment plans . For this reason, further investigations of procedures performed in academic settings, which may influence reporting of MR, are warranted by the Authors .…”

“…According to the Authors, for the remaining 27 155 patients, the lack of MR reporting can have important implications for proper staging and prognostication, arguing that with detailed pathological reports, clinicians may formulate more personalized and effective treatment plans . For this reason, further investigations of procedures performed in academic settings, which may influence reporting of MR, are warranted by the Authors . Surprisingly, the 8th edition of the AJCC cancer staging manual no longer considers MR as T1 sub‐staging criterion, although it remains a major determinant for prognosis in all thickness categories .…”

“…4 The 2009 Committee, in fact, concluded that the histologic diagnosis of all primary Ms should include a MR determination, using a standardized approach, the socalled "hot spot" method. 4 In this regard, Lorimer et al 1 Surprisingly, the 8th edition of the AJCC cancer staging manual no longer considers MR as T1 sub-staging criterion, although it remains a major determinant for prognosis in all thickness categories. 5 In fact, a sub-stratification of T1 M has been achieved adopting a cut-off for the depth of invasion, that is 0.8 mm (T1a: <0.8 mm without ulceration; T1b <0.8 mm with ulceration; or 0.8-1 mm with or without ulceration).…”