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Discordance in the histopathologic diagnosis of difficult melanocytic neoplasms in the clinical setting
Saurabh Lodha1, Sarika Saggar, Julide T Celebi
1Department of Dermatology, Columbia University, New York, NY 10032, USA.
Background:
The gold standard for diagnosing melanocytic neoplasms is by histopathologic examination. However, lack of agreement among expert dermatopathologists in evaluating these tumors has been well established in experimental settings.
Objective:
This study examines the discordance among dermatopathologists in evaluating difficult melanocytic neoplasms in a clinical setting where the diagnosis impacts patient management.
Methods:
Retrospective review of consultation reports over a 6-year period.
Results:
There was complete agreement among the consultants in 54.5% of the cases. However, a high level of disagreement was found in 25% of the cases.
Limitations:
The analysis was limited to two consultant dermatopathologists.
Conclusions:
There are limitations to the practical applications of histologic criteria for diagnosing difficult melanocytic tumors. It is not malpractice for a pathologist to have rendered a diagnosis that did not predict clinical outcome as long as 'standard of care' has been followed in his/her evaluation of the specimen.
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