BACKGROUND Although treatment guidelines exist for melanoma in situ and invasive melanoma, guidelines for other melanocytic skin lesions do not exist. OBJECTIVE To examine pathologists' treatment suggestions for a broad spectrum of melanocytic skin lesions and compare them with existing guidelines. METHODS Pathologists (N = 187) completed a survey and then provided diagnoses and treatment suggestions for 240 melanocytic skin lesions. Physician characteristics associated with treatment suggestions were evaluated with multivariable modeling. RESULTS Treatment suggestions were concordant with National Comprehensive Cancer Network guidelines for the majority of cases interpreted as melanoma in situ (73%) and invasive melanoma (86%). Greater variability of treatment suggestions was seen for other lesion types without existing treatment guidelines. Characteristics associated with provision of treatment suggestions discordant with National Comprehensive Cancer Network guidelines were low caseloads (invasive melanoma), lack of fellowship training or board certification (melanoma in situ), and more than 10 years of experience (invasive melanoma and melanoma in situ). LIMITATIONS Pathologists could not perform immunohistochemical staining or other diagnostic tests; only 1 glass side was provided per biopsy case. CONCLUSIONS Pathologists' treatment suggestions vary significantly for melanocytic lesions, with lower variability for lesion types with national guidelines. Results suggest the need for standardization of treatment guidelines for all melanocytic lesion types.

中文翻译：

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病理学家就黑色素细胞性皮肤病变的治疗建议达成一致。

背景 虽然存在针对原位黑色素瘤和侵袭性黑色素瘤的治疗指南，但不存在针对其他黑色素细胞性皮肤病变的指南。目的检查病理学家对广泛的黑色素细胞性皮肤病变的治疗建议，并将其与现有指南进行比较。方法病理学家（N = 187）完成一项调查，然后对240个黑色素细胞性皮肤病变提供诊断和治疗建议。使用多变量模型评估与治疗建议相关的医师特征。结果 对于大多数被解释为原位黑色素瘤（73%）和侵袭性黑色素瘤（86%）的病例，治疗建议与国家综合癌症网络指南一致。对于没有现有治疗指南的其他病变类型，治疗建议的差异更大。与提供不符合国家综合癌症网络指南的治疗建议相关的特征是低病例数（侵袭性黑色素瘤）、缺乏奖学金培训或委员会认证（原位黑色素瘤）以及超过 10 年的经验（侵袭性黑色素瘤和原位黑色素瘤） . 局限性 病理学家无法进行免疫组织化学染色或其他诊断测试；每个活检病例仅提供 1 个玻璃面。结论 病理学家对黑色素细胞病变的治疗建议差异很大，国家指南中病变类型的变异性较低。结果表明需要对所有黑色素细胞病变类型的治疗指南进行标准化。与提供不符合国家综合癌症网络指南的治疗建议相关的特征是低病例数（侵袭性黑色素瘤）、缺乏奖学金培训或委员会认证（原位黑色素瘤）以及超过 10 年的经验（侵袭性黑色素瘤和原位黑色素瘤） . 局限性 病理学家无法进行免疫组织化学染色或其他诊断测试；每个活检病例仅提供 1 个玻璃面。结论 病理学家对黑色素细胞病变的治疗建议差异很大，国家指南中病变类型的变异性较低。结果表明需要对所有黑色素细胞病变类型的治疗指南进行标准化。与提供不符合国家综合癌症网络指南的治疗建议相关的特征是低病例数（侵袭性黑色素瘤）、缺乏奖学金培训或委员会认证（原位黑色素瘤）以及超过 10 年的经验（侵袭性黑色素瘤和原位黑色素瘤） . 局限性 病理学家无法进行免疫组织化学染色或其他诊断测试；每个活检病例仅提供 1 个玻璃面。结论 病理学家对黑色素细胞病变的治疗建议差异很大，国家指南中病变类型的变异性较低。结果表明需要对所有黑色素细胞病变类型的治疗指南进行标准化。