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Improving Melanoma Path Reports: the Importance of Histopathological Parameters in Diagnosis of Cutaneous Melanoma
Alina Mariana AVRAM, Olga Dana SIMIONESCU, Mariana COSTACHE and Mariana GRIGORE
ABSTRACT
Background: Despite the fact that melanoma is an easy approachable tumor for diagnosis, the incidence of this skin cancer is still increasing. Histopathological assessment of melanocytic tumors is the gold standard in melanoma diagnosis and represents a problematic aspect of dermatology and pathology. Over the past decades many efforts have been made in determining histological characteristics influencing the prognosis and survival of patients with clinically localized primary melanoma. Some of these parameters also proved to be essential for tumor staging and choosing adequate clinical management.
Objective: We present a retrospective study of 21 melanoma cases with histopathological errors or incomplete path reports, with the intention to raise awareness about the importance of an accurate diagnosis for the management of these cases and for patient prognosis.
Methods: We retrospectively reviewed data from pathology reports and discharge medical records from 21 patients diagnosed with melanoma between 2006 and 2014 and treated in other hospitals that presented in our clinic for second opinion. All slides were reviewed by an authorized dermatopathologist and the new path report was compared with the other ones, presented by the patients.
Results: The majority of the path reports were incomplete, with absent (35.7%) or wrong (35.7%) tumor thickness, making impossible to stage the tumor. Absence of histopathological diagnosis was noticed in 3 cases and a wrong diagnosis was determined in 3 patients. Other missing parameters were ulceration status, mitotic rate, microsatellitosis and surgical margins evaluation. missing or incorrect determined in half of the cases.
Conclusions: This study presents the fact that there is a lack of relevant information in the path reports of melanoma cases, making impossible to stage and treat this patients, with adverse clinical impact. We want to emphasize the importance of a standardized histopathological evaluation of melanocytic tumors, consistent with the generally accepted standards, leading to improved healthcare quality and reduced medico legal risks associated with melanoma.
Increased attention to the essential elements for the diagnosis and treatment of melanoma can improve the care of most of these patients and improve prognosis and survival rates.
Keywords: melanoma, path report, error, prognostic factor, Breslow index