Sellheyer Klaus, Bergfeld Wilma F, Stewart Emily, Roberson Gerald, Hammel Jeffrey
Department of Dermatology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Cutan Pathol. 2005 Apr;32(4):293-9. doi: 10.1111/j.0303-6987.2005.00346.x.
Although guidelines are established for reporting tissue specimens of melanomas, such guidelines are not available for reporting surgical margins of benign melanocytic lesions.
We surveyed 582 members of the American Society of Dermatopathology via a web-based questionnaire to evaluate the practice of reporting surgical margins in melanocytic lesions. We were especially interested if the evaluation of margins differs depending on the surgical technique used (shave, punch, and excision) and on the type of melanocytic lesion encountered.
One hundred and fifty-two surveys (26.1%) were returned. Only 32.2% of the dermatopathologists comment routinely on margins of shaved melanocytic nevi and only 33.6% report margins in punch biopsies. More dermatopathologists (57.2%) routinely evaluate excision specimens of melanocytic nevi for margins but still almost half of the survey participants do not report margins in such a common clinical scenario. In contrast, routine evaluation for margins in excised melanomas is high (93.4%). Participants who use the terminology of dysplastic nevi evaluate margins more often and the reporting correlates with the degree of dysplasia. Asked for the terminology used to comment on surgical margins in melanocytic lesions, we observed a great variability in language.
Although clinicians commonly request margin evaluation in melanocytic lesions, dermatopathologists often seem to be reluctant to do so depending on the type of procedure used to remove the lesion. There is a great variability in practice and terminology of when and how to report surgical margins in melanocytic skin lesions.
虽然已制定了黑色素瘤组织标本报告的指南，但对于良性黑素细胞性病变手术切缘的报告尚无此类指南。
我们通过基于网络的问卷对美国皮肤病理学会的582名成员进行了调查，以评估黑素细胞性病变手术切缘的报告情况。我们特别关注切缘评估是否因所采用的手术技术（刮除术、钻孔术和切除术）以及所遇到的黑素细胞性病变类型而异。
共收回152份调查问卷（26.1%）。只有32.2%的皮肤病理学家会常规对刮除的黑素细胞痣切缘进行注释，只有33.6%的人报告钻孔活检的切缘情况。更多的皮肤病理学家（57.2%）会常规评估黑素细胞痣切除标本的切缘，但在这种常见的临床情况下，仍有近一半的调查参与者不报告切缘情况。相比之下，对切除的黑色素瘤切缘进行常规评估的比例很高（93.4%）。使用发育异常痣术语的参与者更常评估切缘，且报告与发育异常程度相关。当被问及用于注释黑素细胞性病变手术切缘的术语时，我们发现语言使用存在很大差异。
虽然临床医生通常要求对黑素细胞性病变进行切缘评估，但皮肤病理学家似乎常常因用于切除病变的手术类型不同而不愿这样做。在黑素细胞性皮肤病变何时以及如何报告手术切缘的实践和术语方面存在很大差异。
