Melanoma histopathology report: proposal for a standardized terminology

Abstract

Dear Editor, Pathology diagnosis is the end result of a complicated and highly sophisticated process, which, through interpretation of morphological alterations, generates data required for patient management. It is largely based on the macroscopic and microscopic features, but also considers any other issue, from clinical history and physical examination, through laboratory and radiological findings, to pathobiological and therapeutic implications. However, the correct diagnosis at the microscope is not the final step. Pathologists still need to transfer the final diagnosis to the clinicians and to provide information on the nature of the disease and diagnosis consequences, i.e., to release a final pathology report. Often, the report has the form of a narrative text, which largely reflects the personality and attitudes of the reporting pathologist. Thus, identical or similar cases may be diagnosed with significant variations in the content of their reports. This may generate unwonted diversities in the clinical evaluation and therapy. Another drawback of a free text report is the omission of critical information required for the clinical outcome and research purposes. Current medical practice is governed by an evidence-based medicine (EBM) approach. The use of standardized pathology reports, based on checklist compilation, is proposed as a major application of EBM to pathology. Such reports provide the basis for consistent reporting. We have recently surveyed the reporting of melanomas by European pathologists and assessed their current practice and opinions on the information required for the final report, via a web-based questionnaire that was diffused through the members of the Dermatopathology Working Group of the European Society of Pathology. The results of the study indicate that pathology reports for primary cutaneous melanoma vary remarkably among laboratories across Europe [1]. Although the most important prognostic features were reported, some key information which may have an influence on prognosis and treatment were often omitted, while other parameters were inadequately standardized. The objects of the current letter are to present Europewide guidelines for the optimization of the pathology report of skin melanoma and to describe the process that has generated the document through the survey evaluation. A preliminary draft of the proposed melanoma report presented during the business meeting of the Dermatopathology Working Group, which was held in Florence, in September 2009 (22nd European Congress of Pathology). Debates focused on the need for a clear-cut distinction between essential (mandatory to be reported) and desirable (optional to be reported) information and on the terminolA. Batistatou (*) Department of Pathology, University of Ioannina, Medical School, University Campus, 1186, 45110 Ioannina, Greece e-mail: abatista@cc.uoi.gr