Characterization of multiple diagnostic terms in melanocytic skin lesion pathology reports. (21st September 2021)

• Record Type: Journal Article
• Authors: Chang, Oliver H.; Elder, David E.; Barnhill, Raymond L.; Piepkorn, Michael W.; Eguchi, Megan M.; Knezevich, Stevan R.; Lee, Annie C.; Moreno, Raul J.; Kerr, Kathleen F.; Elmore, Joann G.
• Is Part Of: Journal of cutaneous pathology. Volume 49:Number 2(2022)
• Page Start: 153
• Page End: 162
• Publication Date: 2021-09-21
• Subjects: borderline diagnosis -- dermatopathologists -- dermatopathology -- diagnostic dilemma -- melanoma -- MELTUMP; Skin -- Diseases -- Periodicals; Dermatology -- Periodicals; 616
• DOI: 10.1111/cup.14126
• Languages: English
• ISSNs: 0303-6987

Abstract

Abstract: Background: Histopathologically ambiguous melanocytic lesions lead some pathologists to list multiple diagnostic considerations in the pathology report. The frequency and circumstance of multiple diagnostic considerations remain poorly characterized. Methods: Two hundred and forty skin biopsy samples were interpreted by 187 pathologists (8976 independent diagnoses) and classified according to a diagnostic/treatment stratification (MPATH‐Dx). Results: Multiple diagnoses in different MPATH‐Dx classes were used in n = 1320 (14.7%) interpretations, with 97% of pathologists and 91% of cases having at least one such interpretation. Multiple diagnoses were more common for intermediate risk lesions and are associated with greater subjective difficulty and lower confidence. We estimate that 6% of pathology reports for melanocytic lesions in the United States contain two diagnoses of different MPATH‐Dx prognostic classes, and 2% of cases are given two diagnoses with significant treatment implications. Conclusions: Difficult melanocytic diagnoses in skin may necessitate multiple diagnostic considerations; however, as patients increasingly access their health records and retrieve pathology reports (as mandated by US law), uncertainty should be expressed unambiguously.