Collaboration between clinicians and pathologists: a necessity for the optimal management of melanoma patients

Pathological assessment of a tissue biopsy is a critical aspect in the multidisciplinary management of melanoma patients because it not only establishes a definite diagnosis in most cases but also provides information that to a major extent influences patient prognosis and directs initial further management. For the pathological report to be as accurate as possible, it is important that the clinician provides the pathologist with an adequate tissue sample and appropriate clinical details. If circumstances permit, an excision biopsy with narrow clearance margins is the most appropriate biopsy of a melanocytic tumour. This will enable an accurate assessment and allow definitive treatment to be planned appropriately if a diagnosis of melanoma is confirmed. Incomplete biopsies (such as shave, punch or curetting biopsies) may impair the accuracy of pathological diagnosis and the assessment of some important parameters and should be avoided if possible. Clinical factors that influence pathological assessment of melanocytic tumours include patient age and sex, the site of the lesion and others factors (such as prior biopsy, other trauma, surface irritation, pregnancy, topical treatment and recent strong sunlight exposure) should be communicated to the pathologist. The latter features may induce atypical pathological features and lead to a misdiagnosis of melanoma. The prognosis for patients with localised primary cutaneous melanoma depends principally on tumour thickness, but other factors such as the presence or absence of ulceration, mitotic rate, Clark level, anatomical site, age and sex are also important. The distance of the tumour from the excision margins and the presence of desmoplasia, neurotropism, regression, satellites or vessel involvement are other features that may affect prognosis and management. It is therefore important that the pathology report details all these factors. The use of a synoptic format pathology report can facilitate this. (author abstract)