Assessing skin cancer histopathology reporting against minimum dataset standards in a low-resource setting

TL;DR

This study evaluates how well skin cancer pathology reports in Palestine meet minimum dataset standards, finding significant gaps in documentation.

Contribution

The study provides a detailed audit of skin cancer reporting in a low-resource setting, highlighting the need for standardized reporting.

Findings

Only 25% of BCC and 39.1% of SCC reports fully documented macroscopic items.

Lesion dimensions were missing in over 48% of BCC and SCC reports.

Most core items were not documented in any of the reports, indicating poor adherence to standards.

Abstract

Structured pathology datasets enhance communication and management by improving clarity, completeness, and accuracy. This study aimed to audit pathology reports of skin cancer in Palestine.

Comprehensive, time-driven sampling was employed by reviewing all pathology reports of melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) from January 2021 to December 2024. The data included sociodemographic variables and the core items published in the dataset for the histological reporting of skin cancers by the Royal College of Pathologists. A completion rate of 90% was selected as the standard of measurement.

None of the included 113 reports documented all items. The macroscopic items were completely reported in 25% and 39.1% of BCC and SCC reports, respectively. For both BCC and SCC, specimen type was reported for all cases, and clinical site was missing in one case of each. The lesion margins were recorded in most reports of BCC (68.7%) and SCC (67.4%). However, macroscopic lesion dimensions were absent in 51.6% of BCC reports and 48.4% of SCC reports. The other items were not mentioned in any report. Only clinical site, specimen type, and the three dimensions of the specimen were included in all melanoma reports. The histopathological subtype was mentioned in only one report.

Skin cancer reports did not document most core items. Implementation of standardized reporting is limited by resource constraints and suboptimal health information system. However, transition from narrative to structured reporting requires the development of national regulations and organizational policies, supported by committed leadership. Exploratory research is recommended to identify the barriers to implementation of structured reporting.