Improving diagnostic accuracy for suspicious melanocytic skin lesions: New Australian melanoma clinical practice guidelines stress the importance of clinician/pathologist communication

Scolyer, Richard A.; Soyer, H. Peter; Kelly, John W.; James, Craig; McLean, Catriona; Coventry, Brendon J.; Ferguson, Peter M.; Rawson, Robert V.; Mar, Victoria; Menezes, Sara Lee de; Fishburn, Paul; Stretch, Jonathan R.; Thompson, John F.

doi:10.31128/ajgp-11-18-4759

Cited by 12 publications

(6 citation statements)

References 18 publications

(27 reference statements)

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“…The cumulative probability of ‘over‐calling’ due to pathology false‐positive diagnosis may be higher than our estimates suggest, as many people will have more than one excision and yet it only takes one false‐positive diagnosis for the person to be labelled with melanoma for life. These findings are in keeping with epidemiological studies that show over recent decades there has been a steady increase in the incidence rates of melanoma reported in most western countries but proportionate increases in mortality have not been observed 18‐25 …”

Section: Discussionsupporting

confidence: 89%

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma

Gibson

Scolyer

Soyer

et al. 2021

Acad Dermatol Venereol

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Background Pathologists sometimes disagree over the histopathologic diagnosis of melanoma. ‘Over‐calling’ and ‘under‐calling’ of melanoma may harm individuals and healthcare systems. Objectives To estimate the extent of ‘over‐calling’ and ‘under‐calling’ of melanoma for a population undergoing one excision per person and to model the impact of potential solutions. Methods In this epidemiological modelling study, we undertook simulations using published data on the prevalence and diagnostic accuracy of melanocytic histopathology in the U.S. population. We simulated results for 10 000 patients each undergoing excision of one melanocytic lesion, interpreted by one community pathologist. We repeated the simulation using a hypothetical intervention that improves diagnostic agreement between community pathologist and a specialist dermatopathologist. We then evaluated four scenarios for how melanocytic lesions judged to be neither clearly benign (post‐test probability of melanoma < 5%), nor clearly malignant (post‐test probability of melanoma > 90%) might be handled, before sending for expert dermatopathologist review to decide the final diagnosis. These were (1) no intervention before expert review, (2) formal second community pathologist review, (3) intervention to increase diagnostic agreement and (4) both the intervention and formal second community pathologist review. The main outcomes were the probability of ‘over‐calling’ and ‘under‐calling’ melanoma, and number of lesions requiring expert referral for each scenario. Results For 10 000 individuals undergoing excision of one melanocytic lesion, interpreted by a community pathologist, a hypothetical intervention to improve histopathology agreement reduced the number of benign lesions ‘over‐called’ as melanoma from 308 to 164 and the number of melanomas ‘under‐called’ from 289 to 240. If all uncertain diagnoses were sent for expert review, the number of referrals would decrease from 1500 to 737 cases if formal second community pathologist review was used, and to 701 cases if the hypothetical intervention was additionally used. Conclusions Interventions to improve histopathology agreement may reduce melanoma ‘over‐calling’ and ‘under‐calling’.

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Section: Discussionsupporting

confidence: 89%

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma

Gibson

Scolyer

Soyer

et al. 2021

Acad Dermatol Venereol

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“…Es kommt immer wieder vor, dass selbst bei erfahrenen Klinikern und Dermatoskopikern eine benigne eingestufte Läsion die unerwartete histologische Diagnose eines Malignoms zutage bringt. Schwierig zu beurteilende Läsionen und insbesondere melanozytäre Neoplasie sollten referenzpathologisch einer Zweitmeinung unterzogen werden [8,9].…”

Section: Welcher Dermatopathologe/ Pathologe Sollte Kritische Melanozytäre Hautveränderungen Beurteilen?unclassified

“…Sind Klinik, Dermatoskopie und Histopathologie diskrepant, ist es sinnvoll, das abweichende diagnostische Ergebnis zu hinterfragen [8,9]. Als Konsequenz daraus kann seitens der Dermatopathologie/ Pathologie das Präparat weiter aufgearbeitet (Stufen-, Serienschnitte, Immunhistochemie etc.…”

Section: Wann Soll Eine Von Klinik Und Dermatoskopie Abweichende Histologie Hinterfragt Werden?unclassified

“…Dermatoskopisch sind in der Literatur bisher 2 Fälle von Spark-Nävi mit atypischem Netzwerk, blauem Schleier und peripheren Globuli beschrieben [17,18]. Ja, auch in der histologischen Diagnostik gibt es Grenzen [8][9][10][11]13]. Eine abschließende Diagnose, die eine melanozytäre Neoplasie nicht eindeutig als benigne oder maligne einstuft, kann vorkommen.…”

Section: Was Ist Ein "Spark-nävus"?unclassified

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Vom Hund über die Dermatoskopie zum Spark-Nävus

Blum¹,

Viehmann²,

Paredes

2021

Hautarzt

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“…Clinically concerning skin lesions are commonly excised to rule out melanoma [1,2]. Common clinical mimics of melanoma, excluding the various forms of naevi, include benign and malignant entities such as seborrheic keratosis (SK), solar lentigo (SL), hemangioma, pigmented actinic keratosis, large cell acanthoma (LCA), lichen planus-like keratosis/lichenoid keratosis (LPLK), pigmented intraepithelial squamous cell carcinoma (ISCC), or even pigmented basal cell carcinoma (BCC) [3].…”

Section: Introductionmentioning

confidence: 99%

Variability in the Histopathological Diagnosis of Nonmelanocytic Lesions Excised to Exclude Melanoma

Katz

Azzi

Lilleyman

et al. 2021

Dermatol Pract Concept

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Introduction. The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions. Objectives. We examined the variability between pathologists in diagnosing non-melanocytic lesions. Methods. As part of a larger study prospectively examining the diagnosis of lesions excised to exclude melanoma in 198 patients at a primary care skin cancer clinic in Newcastle, Australia, we compared diagnosis made by 5 experienced dermatopathologists, of 44 non-melanocytic lesions in 44 patients aged 22-90. Results. Forty-four lesions (out of 217 in total) were non-melanocytic. Among the 5 pathologists who examined each case there was marked variability in the terminology used to diagnose each case. The most common variability was found between seborrheic keratosis, large cell acanthoma, solar lentigo, and lichenoid keratosis. The diagnosis made by the majority of the pathologists was deemed to be the reference diagnosis. Versus majority diagnosis, 4% of benign lesions were considered malignant, and 7% of malignant diagnoses were considered as benign. Conclusions. The different terminology adopted and lack of consensus in the diagnosis of these non-melanocytic lesions in this setting suggests that training AI systems using gold standards may be problematic. We propose a new management classification scheme called MOLEM (Management of Lesions Excised to exclude Melanoma) which expands the previously described MPATH-dx to include non-melanocytic lesions.

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Improving diagnostic accuracy for suspicious melanocytic skin lesions: New Australian melanoma clinical practice guidelines stress the importance of clinician/pathologist communication

Cited by 12 publications

References 18 publications

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma

Estimating the potential impact of interventions to reduce over‐calling and under‐calling of melanoma

Vom Hund über die Dermatoskopie zum Spark-Nävus

Variability in the Histopathological Diagnosis of Nonmelanocytic Lesions Excised to Exclude Melanoma

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