The Influence of Clinical Information in the Histopathologic Diagnosis of Melanocytic Skin Neoplasms

Abstract

BackgroundWe tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).MethodsHistopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.FindingsIn D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2–23). Most diagnostic changes were in D2 (age/sex/location).InterpretationThe histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.

Integrating clinical/dermatoscopic findings and fluorescence in situ hybridization in diagnosing melanocytic neoplasms with less than definitive histopathologic features

“…It has previously been shown that clinical and dermatoscopic data can enhance histopathologic diagnosis of melanoma among pathologists. 10,19 Our series support the use of a combined diagnostic method approach for pigmented lesions to enhance detection of early melanoma. 11,20 In the past decade targeted molecular techniques have become available to further assist in the diagnosis of histologically challenging melanocytic neoplasms.…”

Influence of evaluation of clinical pictures on the histopathologic diagnosis of inflammatory skin disorders

“…The need for appropriate clinical correlation and clinical images has already been underlined. 8,9 Recently, the usefulness of clinicopathologic correlation for the histopathologic diagnosis of melanocytic skin tumor was demonstrated, 3,6 and it was suggested that all biopsy specimens of clinically difficult pigmented lesions should be assessed histopathologically with knowledge of the clinical picture. 10 In this context, we stress that dermatopathology is macroscopic and microscopic pathology of the skin, and that evaluation of clinical presentation (macroscopy) represents a crucial step in the diagnostic process.…”

“…Particularly for pigmented skin tumors, the feasibility of teledermatology has been successfully evaluated in several studies, even with the use of cellular phoneebased cameras. [2][3][4][5][6] The current study was performed to verify whether the evaluation of clinical pictures increases the accuracy of dermatopathologic diagnosis of inflammatory skin disorders.…”

Dermatologists, General Practitioners, and the Best Method to Biopsy Suspect Melanocytic Neoplasms

“…19 Our research group 20 has suggested a technique whereby the clinician sends a dermoscopic image of the lesion to the pathologist, who then uses the image during gross examination as a tool to identify the dermoscopically suspect areas that are annotated on the image. 20 In addition, step sectioning of melanocytic lesions decreases the chance of sampling errors.…”