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. Rising utilization — and substantial geographic variation in practice patterns — argue for further research to optimize IHC use in the diagnoses of melanoma, according to the authors.
But with sparse guidance regarding best practices for IHC in melanoma diagnosis, concerns for appropriate use are rising, they wrote in their report, recently published in JAMA Dermatology.
Kenechukwu Ojukwu, MD, MPP, of the department of pathology and laboratory medicine, University of California, Los Angeles, and coinvestigators, searched the Surveillance, Epidemiology, and End Results (SEER)–Medicare database for incident in situ or invasive cutaneous melanoma in patients 65 years and older and accompanying IHC claims made during the month of diagnosis through 14 days afterward.
Among 132,547 melanomas in 116,117 patients, 43,396 (33%) had accompanying IHC claims. Such claims were less common with increasing age, declining from 44% in patients aged 65-74 years to 18% in patients 85 aged years and older. Although melanoma incidence increased throughout the period studied, melanoma mortality rates remained relatively stable.
By summary stage at diagnosis, IHC utilization ranged from 29% of in situ cases to 75% of distant cases. After the researchers controlled for year of diagnosis, IHC use was statistically significantly associated with all demographic, tumor, and geographic characteristics examined, except race and ethnicity. Across all the years of the study, regional usage ranged from a low of 22% in Detroit to a high of 44% in both Louisiana and San Jose-Monterey, California. Figures for 2017 ranged from 39% of cases in Kentucky and Atlanta to 68% in New Mexico.
[embed:render:related:node:268401]
“Given the extensive use of IHC in clinical practice,” the authors concluded, “studies examining the resulting outcomes of IHC on different domains, such as symptom burden, quality of life, and mortality, are crucial.”
The “notable” regional variation in IHC utilization suggests uncertainty about its optimal employment in clinical practice, and, they wrote, “these findings highlight the need for research to identify where IHC provides the most value and to develop guidelines regarding the appropriate use of IHC.”
In an accompanying JAMA Dermatology editorial, Alexandra Flamm, MD, wrote, “now is an exciting time to practice dermatopathology, with an increased number of ancillary tests, such as IHC, that can be used to diagnose malignant neoplasms more precisely and to more accurately determine prognosis and therapeutic options in this age of precision medicine”.
However, added Dr. Flamm, a dermatologist and dermatopathologist at New York University, New York City, the increasing number of ancillary tests is fueling awareness of appropriate use and the importance of ensuring high-quality, value-based healthcare. “With this increased scrutiny on the appropriateness of ancillary histopathologic testing within dermatopathology,” she wrote, “the need is growing for parameters that can be used to guide when to use IHC testing and other ancillary testing.” And using dermatopathologist-developed tools such as American Society of Dermatopathology guidelines for 11 IHC tests can help ensure that appropriate medical decision-making is taken into account when creating these tools, she added.
IHC Usage Growing
“The paper confirms what I already knew,” said Whitney High, MD, JD, who was not involved with the study and was asked to comment on the results. “Use of IHC in dermatopathology has increased substantially, and probably will continue to increase over time.” The societal burden of IHC costs represents a legitimate concern, said Dr. High, professor of dermatology and pathology and director of dermatopathology at the University of Colorado, Aurora.
“However,” he told this news organization, “the histologic diagnosis of melanoma is sometimes substantially subjective — and all physicians, including pathologists, even though they are not providing care in the physical presence of the patient, are fiduciaries.” If an IHC stain would meaningfully improve a patient’s care, he said, physicians should attempt to provide it, unless strictly disallowed by a payer. Controlling medical-care costs might be better left to professional societies to guide care standards over time, he noted.
IHC has the potential to improve the accuracy and reliability of melanoma assessments by providing additional data, said Dr. High.“To this end, disallowing the use of immunostains simply due to cost, without substantial evidence, has the potential to alter diagnoses and impact care negatively.” This is particularly true for melanoma, he said, where “finding even one additional melanoma with IHC has life-altering consequences for that patient.”
How IHC might impact melanoma overdiagnosis remains unclear without additional study. IHC might allow dermatologists to avoid diagnosing melanoma in borderline cases unsupported by IHC, explained Dr. High, or false-positive results could further fuel melanoma overdiagnosis.
Limitations of the IHC paper included an inability to determine whether IHC improved outcomes. Additional shortcomings included use of a SEER-specific older population. And because CPT codes are not site-specific, some samples may have come from surgical margins or non-skin locations.
Study authors reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. The study was funded by the University of California, Los Angeles (UCLA) National Clinician Scholars Program, the UCLA Department of Pathology, the California Department of Public Health, and the NCI. Dr. High reports no relevant financial interests.
. Rising utilization — and substantial geographic variation in practice patterns — argue for further research to optimize IHC use in the diagnoses of melanoma, according to the authors.
But with sparse guidance regarding best practices for IHC in melanoma diagnosis, concerns for appropriate use are rising, they wrote in their report, recently published in JAMA Dermatology.
Kenechukwu Ojukwu, MD, MPP, of the department of pathology and laboratory medicine, University of California, Los Angeles, and coinvestigators, searched the Surveillance, Epidemiology, and End Results (SEER)–Medicare database for incident in situ or invasive cutaneous melanoma in patients 65 years and older and accompanying IHC claims made during the month of diagnosis through 14 days afterward.
Among 132,547 melanomas in 116,117 patients, 43,396 (33%) had accompanying IHC claims. Such claims were less common with increasing age, declining from 44% in patients aged 65-74 years to 18% in patients 85 aged years and older. Although melanoma incidence increased throughout the period studied, melanoma mortality rates remained relatively stable.
By summary stage at diagnosis, IHC utilization ranged from 29% of in situ cases to 75% of distant cases. After the researchers controlled for year of diagnosis, IHC use was statistically significantly associated with all demographic, tumor, and geographic characteristics examined, except race and ethnicity. Across all the years of the study, regional usage ranged from a low of 22% in Detroit to a high of 44% in both Louisiana and San Jose-Monterey, California. Figures for 2017 ranged from 39% of cases in Kentucky and Atlanta to 68% in New Mexico.
[embed:render:related:node:268401]
“Given the extensive use of IHC in clinical practice,” the authors concluded, “studies examining the resulting outcomes of IHC on different domains, such as symptom burden, quality of life, and mortality, are crucial.”
The “notable” regional variation in IHC utilization suggests uncertainty about its optimal employment in clinical practice, and, they wrote, “these findings highlight the need for research to identify where IHC provides the most value and to develop guidelines regarding the appropriate use of IHC.”
In an accompanying JAMA Dermatology editorial, Alexandra Flamm, MD, wrote, “now is an exciting time to practice dermatopathology, with an increased number of ancillary tests, such as IHC, that can be used to diagnose malignant neoplasms more precisely and to more accurately determine prognosis and therapeutic options in this age of precision medicine”.
However, added Dr. Flamm, a dermatologist and dermatopathologist at New York University, New York City, the increasing number of ancillary tests is fueling awareness of appropriate use and the importance of ensuring high-quality, value-based healthcare. “With this increased scrutiny on the appropriateness of ancillary histopathologic testing within dermatopathology,” she wrote, “the need is growing for parameters that can be used to guide when to use IHC testing and other ancillary testing.” And using dermatopathologist-developed tools such as American Society of Dermatopathology guidelines for 11 IHC tests can help ensure that appropriate medical decision-making is taken into account when creating these tools, she added.
IHC Usage Growing
“The paper confirms what I already knew,” said Whitney High, MD, JD, who was not involved with the study and was asked to comment on the results. “Use of IHC in dermatopathology has increased substantially, and probably will continue to increase over time.” The societal burden of IHC costs represents a legitimate concern, said Dr. High, professor of dermatology and pathology and director of dermatopathology at the University of Colorado, Aurora.
“However,” he told this news organization, “the histologic diagnosis of melanoma is sometimes substantially subjective — and all physicians, including pathologists, even though they are not providing care in the physical presence of the patient, are fiduciaries.” If an IHC stain would meaningfully improve a patient’s care, he said, physicians should attempt to provide it, unless strictly disallowed by a payer. Controlling medical-care costs might be better left to professional societies to guide care standards over time, he noted.
IHC has the potential to improve the accuracy and reliability of melanoma assessments by providing additional data, said Dr. High.“To this end, disallowing the use of immunostains simply due to cost, without substantial evidence, has the potential to alter diagnoses and impact care negatively.” This is particularly true for melanoma, he said, where “finding even one additional melanoma with IHC has life-altering consequences for that patient.”
How IHC might impact melanoma overdiagnosis remains unclear without additional study. IHC might allow dermatologists to avoid diagnosing melanoma in borderline cases unsupported by IHC, explained Dr. High, or false-positive results could further fuel melanoma overdiagnosis.
Limitations of the IHC paper included an inability to determine whether IHC improved outcomes. Additional shortcomings included use of a SEER-specific older population. And because CPT codes are not site-specific, some samples may have come from surgical margins or non-skin locations.
Study authors reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. The study was funded by the University of California, Los Angeles (UCLA) National Clinician Scholars Program, the UCLA Department of Pathology, the California Department of Public Health, and the NCI. Dr. High reports no relevant financial interests.
. Rising utilization — and substantial geographic variation in practice patterns — argue for further research to optimize IHC use in the diagnoses of melanoma, according to the authors.
But with sparse guidance regarding best practices for IHC in melanoma diagnosis, concerns for appropriate use are rising, they wrote in their report, recently published in JAMA Dermatology.
Kenechukwu Ojukwu, MD, MPP, of the department of pathology and laboratory medicine, University of California, Los Angeles, and coinvestigators, searched the Surveillance, Epidemiology, and End Results (SEER)–Medicare database for incident in situ or invasive cutaneous melanoma in patients 65 years and older and accompanying IHC claims made during the month of diagnosis through 14 days afterward.
Among 132,547 melanomas in 116,117 patients, 43,396 (33%) had accompanying IHC claims. Such claims were less common with increasing age, declining from 44% in patients aged 65-74 years to 18% in patients 85 aged years and older. Although melanoma incidence increased throughout the period studied, melanoma mortality rates remained relatively stable.
By summary stage at diagnosis, IHC utilization ranged from 29% of in situ cases to 75% of distant cases. After the researchers controlled for year of diagnosis, IHC use was statistically significantly associated with all demographic, tumor, and geographic characteristics examined, except race and ethnicity. Across all the years of the study, regional usage ranged from a low of 22% in Detroit to a high of 44% in both Louisiana and San Jose-Monterey, California. Figures for 2017 ranged from 39% of cases in Kentucky and Atlanta to 68% in New Mexico.
[embed:render:related:node:268401]
“Given the extensive use of IHC in clinical practice,” the authors concluded, “studies examining the resulting outcomes of IHC on different domains, such as symptom burden, quality of life, and mortality, are crucial.”
The “notable” regional variation in IHC utilization suggests uncertainty about its optimal employment in clinical practice, and, they wrote, “these findings highlight the need for research to identify where IHC provides the most value and to develop guidelines regarding the appropriate use of IHC.”
In an accompanying JAMA Dermatology editorial, Alexandra Flamm, MD, wrote, “now is an exciting time to practice dermatopathology, with an increased number of ancillary tests, such as IHC, that can be used to diagnose malignant neoplasms more precisely and to more accurately determine prognosis and therapeutic options in this age of precision medicine”.
However, added Dr. Flamm, a dermatologist and dermatopathologist at New York University, New York City, the increasing number of ancillary tests is fueling awareness of appropriate use and the importance of ensuring high-quality, value-based healthcare. “With this increased scrutiny on the appropriateness of ancillary histopathologic testing within dermatopathology,” she wrote, “the need is growing for parameters that can be used to guide when to use IHC testing and other ancillary testing.” And using dermatopathologist-developed tools such as American Society of Dermatopathology guidelines for 11 IHC tests can help ensure that appropriate medical decision-making is taken into account when creating these tools, she added.
IHC Usage Growing
“The paper confirms what I already knew,” said Whitney High, MD, JD, who was not involved with the study and was asked to comment on the results. “Use of IHC in dermatopathology has increased substantially, and probably will continue to increase over time.” The societal burden of IHC costs represents a legitimate concern, said Dr. High, professor of dermatology and pathology and director of dermatopathology at the University of Colorado, Aurora.
“However,” he told this news organization, “the histologic diagnosis of melanoma is sometimes substantially subjective — and all physicians, including pathologists, even though they are not providing care in the physical presence of the patient, are fiduciaries.” If an IHC stain would meaningfully improve a patient’s care, he said, physicians should attempt to provide it, unless strictly disallowed by a payer. Controlling medical-care costs might be better left to professional societies to guide care standards over time, he noted.
IHC has the potential to improve the accuracy and reliability of melanoma assessments by providing additional data, said Dr. High.“To this end, disallowing the use of immunostains simply due to cost, without substantial evidence, has the potential to alter diagnoses and impact care negatively.” This is particularly true for melanoma, he said, where “finding even one additional melanoma with IHC has life-altering consequences for that patient.”
How IHC might impact melanoma overdiagnosis remains unclear without additional study. IHC might allow dermatologists to avoid diagnosing melanoma in borderline cases unsupported by IHC, explained Dr. High, or false-positive results could further fuel melanoma overdiagnosis.
Limitations of the IHC paper included an inability to determine whether IHC improved outcomes. Additional shortcomings included use of a SEER-specific older population. And because CPT codes are not site-specific, some samples may have come from surgical margins or non-skin locations.
Study authors reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. The study was funded by the University of California, Los Angeles (UCLA) National Clinician Scholars Program, the UCLA Department of Pathology, the California Department of Public Health, and the NCI. Dr. High reports no relevant financial interests.
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<root generator="drupal.xsl" gversion="1.7"> <header> <fileName>167313</fileName> <TBEID>0C04EFF5.SIG</TBEID> <TBUniqueIdentifier>MD_0C04EFF5</TBUniqueIdentifier> <newsOrJournal>News</newsOrJournal> <publisherName>Frontline Medical Communications</publisherName> <storyname>IHC and melanoma dx</storyname> <articleType>2</articleType> <TBLocation>QC Done-All Pubs</TBLocation> <QCDate>20240403T164222</QCDate> <firstPublished>20240403T164539</firstPublished> <LastPublished>20240403T164539</LastPublished> <pubStatus qcode="stat:"/> <embargoDate/> <killDate/> <CMSDate>20240403T164539</CMSDate> <articleSource>FROM JAMA DERMATOLOGY</articleSource> <facebookInfo/> <meetingNumber/> <byline>John Jesitus</byline> <bylineText>JOHN JESITUS</bylineText> <bylineFull>JOHN JESITUS</bylineFull> <bylineTitleText/> <USOrGlobal/> <wireDocType/> <newsDocType>News</newsDocType> <journalDocType/> <linkLabel/> <pageRange/> <citation/> <quizID/> <indexIssueDate/> <itemClass qcode="ninat:text"/> <provider qcode="provider:imng"> <name>IMNG Medical Media</name> <rightsInfo> <copyrightHolder> <name>Frontline Medical News</name> </copyrightHolder> <copyrightNotice>Copyright (c) 2015 Frontline Medical News, a Frontline Medical Communications Inc. company. All rights reserved. This material may not be published, broadcast, copied, or otherwise reproduced or distributed without the prior written permission of Frontline Medical Communications Inc.</copyrightNotice> </rightsInfo> </provider> <abstract/> <metaDescription>A retrospective analysis of Medicare data revealed that between 2000 and 2017, immunohistochemistry (IHC) claims associated with melanoma diagnoses grew from 11</metaDescription> <articlePDF/> <teaserImage>300989</teaserImage> <teaser>The use of immunohistochemistry among Medicare patients with melanoma grew between 2000 and 2017, but substantial regional variations highlight a need for further research.</teaser> <title>Immunohistochemistry May Improve Melanoma Diagnosis</title> <deck/> <disclaimer/> <AuthorList/> <articleURL/> <doi/> <pubMedID/> <publishXMLStatus/> <publishXMLVersion>1</publishXMLVersion> <useEISSN>0</useEISSN> <urgency/> <pubPubdateYear/> <pubPubdateMonth/> <pubPubdateDay/> <pubVolume/> <pubNumber/> <wireChannels/> <primaryCMSID/> <CMSIDs/> <keywords/> <seeAlsos/> <publications_g> <publicationData> <publicationCode>skin</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>fp</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>im</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> <publicationData> <publicationCode>oncr</publicationCode> <pubIssueName/> <pubArticleType/> <pubTopics/> <pubCategories/> <pubSections/> </publicationData> </publications_g> <publications> <term canonical="true">13</term> <term>15</term> <term>21</term> <term>31</term> </publications> <sections> <term>27970</term> <term canonical="true">39313</term> </sections> <topics> <term canonical="true">244</term> <term>204</term> <term>203</term> <term>263</term> </topics> <links> <link> <itemClass qcode="ninat:picture"/> <altRep contenttype="image/jpeg">images/240127d5.jpg</altRep> <description role="drol:caption">Dr. Whitney High</description> <description role="drol:credit">Dr. High</description> </link> </links> </header> <itemSet> <newsItem> <itemMeta> <itemRole>Main</itemRole> <itemClass>text</itemClass> <title>Immunohistochemistry May Improve Melanoma Diagnosis</title> <deck/> </itemMeta> <itemContent> <p><span class="tag metaDescription">A retrospective analysis of Medicare data revealed that between 2000 and 2017, immunohistochemistry (IHC) claims associated with melanoma diagnoses grew from 11% to 51%</span>. Rising utilization — and substantial geographic variation in practice patterns — argue for further research to optimize IHC use in the diagnoses of melanoma, according to the authors.</p> <p>But with sparse guidance regarding best practices for IHC in melanoma diagnosis, concerns for appropriate use are rising, they wrote in their <span class="Hyperlink"><a href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2815634">report</a></span>, recently published in <i>JAMA Dermatology</i>. <br/><br/>Kenechukwu Ojukwu, MD, MPP, of the department of pathology and laboratory medicine, University of California, Los Angeles, and coinvestigators, searched the Surveillance, Epidemiology, and End Results (SEER)–Medicare database for incident <i>in situ</i> or invasive cutaneous melanoma in patients 65 years and older and accompanying IHC claims made during the month of diagnosis through 14 days afterward.<br/><br/>Among 132,547 melanomas in 116,117 patients, 43,396 (33%) had accompanying IHC claims. Such claims were less common with increasing age, declining from 44% in patients aged 65-74 years to 18% in patients 85 aged years and older. Although melanoma incidence increased throughout the period studied, melanoma mortality rates remained relatively stable.<br/><br/>By summary stage at diagnosis, IHC utilization ranged from 29% of <i>in situ</i> cases to 75% of distant cases. After the researchers controlled for year of diagnosis, IHC use was statistically significantly associated with all demographic, tumor, and geographic characteristics examined, except race and ethnicity. Across all the years of the study, regional usage ranged from a low of 22% in Detroit to a high of 44% in both Louisiana and San Jose-Monterey, California. Figures for 2017 ranged from 39% of cases in Kentucky and Atlanta to 68% in New Mexico.<br/><br/>“Given the extensive use of IHC in clinical practice,” the authors concluded, “studies examining the resulting outcomes of IHC on different domains, such as symptom burden, quality of life, and mortality, are crucial.”<br/><br/>The “notable” regional variation in IHC utilization suggests uncertainty about its optimal employment in clinical practice, and, they wrote, “these findings highlight the need for research to identify where IHC provides the most value and to develop guidelines regarding the appropriate use of IHC.”<br/><br/>In an accompanying <i>JAMA Dermatology</i> <span class="Hyperlink"><a href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2815631">editorial</a></span>, <span class="Hyperlink"><a href="https://nyulangone.org/doctors/1619243698/alexandra-flamm">Alexandra Flamm, MD</a></span>, wrote, “now is an exciting time to practice dermatopathology, with an increased number of ancillary tests, such as IHC, that can be used to diagnose malignant neoplasms more precisely and to more accurately determine prognosis and therapeutic options in this age of precision medicine”. <br/><br/>However, added Dr. Flamm, a dermatologist and dermatopathologist at New York University, New York City, the increasing number of ancillary tests is fueling awareness of appropriate use and the importance of ensuring high-quality, value-based healthcare. “With this increased scrutiny on the appropriateness of ancillary histopathologic testing within dermatopathology,” she wrote, “the need is growing for parameters that can be used to guide when to use IHC testing and other ancillary testing.” And using dermatopathologist-developed tools such as American Society of Dermatopathology <span class="Hyperlink"><a href="https://onlinelibrary.wiley.com/doi/10.1111/cup.14135">guidelines</a></span> for 11 IHC tests can help ensure that appropriate medical decision-making is taken into account when creating these tools, she added.</p> <h2><br/><br/>IHC Usage Growing</h2> <p>“The paper confirms what I already knew,” said <span class="Hyperlink"><a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/13101">Whitney High, MD, JD</a></span>, who was not involved with the study and was asked to comment on the results. “Use of IHC in dermatopathology has increased substantially, and probably will continue to increase over time.” The societal burden of IHC costs represents a legitimate concern, said Dr. High, professor of dermatology and pathology and director of dermatopathology at the Un<span class="Hyperlink">iversity of Colorado, </span>Aurora.</p> <p>“However,” he told this news organization, “the histologic diagnosis of melanoma is sometimes substantially subjective — and all physicians, including pathologists, even though they are not providing care in the physical presence of the patient, are fiduciaries.” If an IHC stain would meaningfully improve a patient’s care, he said, physicians should attempt to provide it, unless strictly disallowed by a payer. Controlling medical-care costs might be better left to professional societies to guide care standards over time, he noted.[[{"fid":"300989","view_mode":"medstat_image_flush_left","fields":{"format":"medstat_image_flush_left","field_file_image_alt_text[und][0][value]":"Whitney High, MD, JD, professor of dermatology and pathology and director of dermatopathology at the University of Colorado School of Medicine in Aurora","field_file_image_credit[und][0][value]":"Dr. High","field_file_image_caption[und][0][value]":"Dr. Whitney High"},"type":"media","attributes":{"class":"media-element file-medstat_image_flush_left"}}]]<br/><br/>IHC has the potential to improve the accuracy and reliability of melanoma assessments by providing additional data, said Dr. High.“To this end, disallowing the use of immunostains simply due to cost, without substantial evidence, has the potential to alter diagnoses and impact care negatively.” This is particularly true for melanoma, he said, where “finding even one additional melanoma with IHC has life-altering consequences for that patient.”<br/><br/>How IHC might impact melanoma overdiagnosis remains unclear without additional study. IHC might allow dermatologists to avoid diagnosing melanoma in borderline cases unsupported by IHC, explained Dr. High, or false-positive results could further fuel melanoma overdiagnosis.<br/><br/>Limitations of the IHC paper included an inability to determine whether IHC improved outcomes. Additional shortcomings included use of a SEER-specific older population. And because CPT codes are not site-specific, some samples may have come from surgical margins or non-skin locations. <br/><br/>Study authors reported receiving grants from the <span class="Hyperlink"><a href="https://www.cancer.gov/">National Cancer Institute</a></span> (NCI) during the conduct of the study. The study was funded by the <span class="Hyperlink"><a href="https://uclancsp.med.ucla.edu/">University of California, Los Angeles (UCLA) National Clinician Scholars Program</a></span>, the UCLA Department of Pathology, the California Department of Public Health, and the NCI. Dr. High reports no relevant financial interests. </p> </itemContent> </newsItem> <newsItem> <itemMeta> <itemRole>teaser</itemRole> <itemClass>text</itemClass> <title/> <deck/> </itemMeta> <itemContent> </itemContent> </newsItem> </itemSet></root>
FROM JAMA DERMATOLOGY
