Dr Akkooi on Pathologic Review Discrepancies and Overtreatment Risks in Metastatic Melanoma
Source: OncLive, January 2025
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.