Commentary
Video
Alexander C.J. Van Akkooi, MD, PhD, FRACS, discusses how discrepancies in local and central pathologic review can expose patients to potential toxicities associated with overtreatment for metastatic melanoma.
"[The original diagnosis] was based on the [findings of a] local pathologist. [The stage of the diagnosis] can be very impactful for patients who might receive management based on the decision of the local pathologist [to call] call it a metastatic melanoma. [Corresponding treatment] could be systemic therapy or surgery, and [there are] potential complications and toxicities associated with that."
Alexander C.J. Van Akkooi, MD, PhD, FRACS, chair, Melanoma Surgery, Melanoma Institute Australia; associate professor, University of Sydney, discusses findings from the prospective EORTC-1208-MG registry study (NCT01942603), which, in addition to evaluating the outcomes of patients with minimal sentinel node tumor burden who were managed without complete lymph node dissection, evaluated the accuracy of local pathological review in diagnosing metastatic melanoma.
In this multicenter registry study, van Akkooi notes that investigators conducted central pathological reviews of lesions initially classified as metastatic melanoma by local pathologists. The analysis confirmed that 11% of lesions diagnosed as metastatic melanoma were nonmetastatic upon central review. This misclassification could lead to unnecessary systemic therapy or surgery, exposing patients to potential toxicities and complications associated with overtreatment.
This discrepancy highlights the need for improved diagnostic accuracy, van Akkooi emphasizes, noting the importance of educating pathologists on the challenges of diagnosing small or ambiguous lesions. He also recommended implementing a secondary review board for cases by independent pathologists to ensure diagnostic precision and reduce the likelihood of overtreatment. These measures could improve patient outcomes by preventing unnecessary therapies and interventions, he notes.
The EORTC-1208-MG registry study also established a biobank of tissue, plasma, and serum samples for future translational research. These biospecimens will enable the investigation of biomarkers and molecular characteristics associated with melanoma, potentially enhancing diagnostic and therapeutic strategies.
Van Akkooi notes that ongoing collaborative efforts are focused on evaluating whether insights from the study can be incorporated into the forthcoming 9th edition of the American Joint Committee on Cancer staging system.