Surgical and Pathological Documentation and Compliance With Consensus Guidelines in Patients With Thin Melanoma at a Community Teaching Hospital

The purpose of this study was to evaluate surgical and pathological compliance with consensus guidelines in patients with thin melanoma, compare overall compliance between surgical subspecialties, and assess the quality and consistency of documentation among surgeons and pathologists in our community teaching hospital. Category Adherence (n/%) Biopsy pathology reports Reporting rounding scheme (n = 82) a 73 (89.0%) Reporting peripheral margin (n = 52) b 40 (76.9%) Reporting deep margin (n = 52) b 35 (67.3%) Reporting mitotic index (n = 52) b 51 (98.1%) Reporting clinical stage (n = 52) b 51 (98.1%) Reporting ulceration (n = 52) b 51 (98.1%) Reporting histological type (n = 52) b 24 (46.1%) Reporting n (%) Final pathology reports (n = 80) Patients without residual melanoma (n = 62) Synoptic report 21 (33.9%) Breslow depth 15 (24.2%) Ulceration 15 (24.2%) Mitotic index 14 (22.6%) Histological type 14 (22.6%) Final pathologic stage 21 (33.9%) Patients with residual in situ melanoma (n = 12) Synoptic report 10 (83.3%) Breslow depth 6 (50.0%) Ulceration 7 (58.3%) Mitotic index 6 (50.0%) Histological type 7 (58.3%) Peripheral margins 12 (100.0%) Deep margins 11 (91.7%) Final pathologic stage 11 (91.7%) Patients with residual melanoma (n = 6) Synoptic report 6 (100.0%) Breslow depth 6 (100.0%) Ulceration 6 (100.0%) Mitotic index 6 (100.0%) Histological type 5 (83.3%) Peripheral margins 6 (100.0%) Deep margins 6 (100.0%) Final pathologic stage 6 (100.0%) aBreslow depth for the patients with missing biopsy reports was located in the surgeon’s history and physical notes and operative reports. b52/82 biopsy reports were available in the electronic medical record (EMR). Clear documentation of these end points and documentation of practice in accordance with consensus guidelines are lacking, which inhibits the ability to assess overall quality of care.