Original articleDiscordance of histopathologic parameters in cutaneous melanoma: Clinical implications
Section snippets
Methods
After institutional review board approval, a retrospective review was performed of cutaneous melanoma cases referred to our institution from January 2009 to December 2014. It is policy at EUH that outside slides from original melanoma biopsy specimens are reviewed by a board-certified dermatopathologist at our institution before undergoing additional treatment. Referrals to EUH were made for routine treatment of melanoma, not for expert second opinion for diagnosis. Intrainstitutional
Results
Of the 871 cases of cutaneous melanoma referred to EUH for review between 2009 and 2014, 588 had available outside pathology reports and were included in the study. These represented interpretations by a total of 119 outside pathologists and 5 EUH dermatopathologists.
Discordance between outside and internal reports are presented in Table I. Changes in final diagnosis occurred in 11 (2%) cases (atypical melanocytic proliferation to invasive melanoma [3], melanoma in situ to invasive melanoma
Discussion
This study highlights the discordance among pathologists in the reporting of melanoma microstaging parameters. Although to our knowledge no previous studies have conducted a review on this scale and limited cases exclusively to melanoma or melanoma in situ, similar results have been reported. In a study by Hawryluk et al6 of diagnostically challenging pigmented lesions referred to a tertiary care center, the diagnostic discordance rate was 35%, resulting in a change in therapy in 13% of cases.
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2023, PathologyCitation Excerpt :Possible candidates include various forms of ‘pseudomelanoma’ including some that have been described and no doubt others that have yet to be described.38 The published experience of clinical groups that review outside slides prior to treatment in their institutions, where there is generally only a small subset of cases with disagreement that results in a change in diagnosis (although changes in management are not uncommon),39 suggests that there is not a very large number of such lesions being (recognisably) misdiagnosed as melanoma in the community. There has been recent evidence presented that some examples of lesions that are truly Spitz tumours may be indistinguishable from more usual melanomas (without sophisticated genomic testing) and these might form a significant subset of pseudomelanomas.40
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Funding sources: None.
Disclosure: Dr Stuart serves on the Board of Governors for the College of American Pathologists. Drs Patrawala, Maley, Parker, Swerlick, and Stoff, and Ms Greskovich have no conflicts of interest to declare.
The findings from this research study were submitted as a meeting abstract to the American Society of Dermatopathology Conference, San Francisco, CA, October 8-11, 2015.