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Pathological review of primary cutaneous malignant melanoma by a specialist skin cancer multidisciplinary team improves patient care in the UK
  1. Bevin Bhoyrul1,
  2. Geoffrey Brent1,
  3. Faye Elliott2,
  4. Joanna McLorinan1,
  5. Amy Wilson1,
  6. Howard Peach3,
  7. Bipin Mathew4,
  8. Angana Mitra1
  1. 1 Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2 Department of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, Leeds, UK
  3. 3 Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4 Department of Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Bevin Bhoyrul, Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK; bevin.bhoyrul{at}nhs.net

Abstract

Aims The National Institute for Health and Care Excellence advocated the development of specialist skin cancer multidisciplinary teams (SSMDTs) for the management of higher risk invasive skin cancers in the UK. The interobserver variability in the histopathological assessment of primary cutaneous malignant melanoma (PCMM) is well recognised.

Methods We evaluated the discordance rates in the assessment of the histopathological criteria of PCMM based on the eighth American Joint Committee on Cancer (AJCC) melanoma staging system and subsequent change in prognosis and management following pathology review by an SSMDT.

Results 353 cases of PCMM were referred to our SSMDT between April 2015 and May 2016. Cases in which there was a discrepancy in one or more histological parameters following expert review were collected retrospectively. Of 341 eligible cases, there were 94 (27.6%) in which there was an alteration in any parameter. There was interobserver agreement in final diagnosis in 96.8%, Breslow thickness in 86.8%, ulceration in 98.2%, microsatellites in 98.5%, tumour mitotic rate in 88.9%, histological subtype in 92.4%, growth phase in 98.5%, angiolymphatic invasion in 97.7%, perineural invasion in 98.8%, regression in 95.3% and tumour-infiltrating lymphocytes in 95.0%. A corresponding change in AJCC stage occurred in 23 cases (6.7%), with a resulting change in clinical management in 10 cases (2.9%).

Conclusions Disagreements in the pathological assessment of PCMM can have significant clinical implications for a small number of patients. Our findings highlight the value of the SSMDT for high-quality care of patients with melanoma in the UK.

  • malignant melanoma
  • discordance
  • discrepancies
  • pathology
  • dermatopathology
  • multidisciplinary team
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Footnotes

  • Handling editor Runjan Chetty.

  • Contributors BB, GB, AW and JML performed the research. HP, MB and AM designed the study. BB, GB and FE analysed the data. BB and GB drafted the manuscript. All the authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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