Evaluating Diagnostic Concordance in Dermatopathology: Insights from a Sub-Saharan African Cohort

Accurate diagnosis of skin disorders relies heavily on clinical examination, supplemented by histopathological evaluation when biopsies are performed. The degree of concordance between clinical and histopathological diagnoses is a key quality indicator and educational tool in dermatologic practice. This study aimed to evaluate clinicopathologic diagnostic concordance in skin biopsies performed at a tertiary dermatology clinic in a sub-Saharan African country.

A retrospective analysis of skin biopsies was conducted to determine the rate of full, partial, and non-concordance between clinical and histopathological diagnoses. Concordance was also assessed across anatomical sites, patient demographics, and diagnostic categories.

Among the biopsies reviewed, the overall clinicopathologic concordance rate was 64.2%. Full concordance was significantly more common in males than females (55.7% vs 44.3%, p = 0.02). In bivariate analysis, sex was the only variable significantly associated with diagnostic concordance (p = 0.019), with higher concordance observed among male patients. In contrast, multivariable analysis identified eczematous disorders as being associated with a markedly increased likelihood of diagnostic non-concordance compared with tumor categories (AOR = 6.38; 95% CI: 2.06-19.8; p = 0.001). Concordance was highest among tumors, papulosquamous diseases, and infections, with pigmentation disorders also demonstrating relatively high concordance. Partial concordance was most frequently observed in collagen disorders, pigmentation disorders, and inflammatory dermatoses.

These findings demonstrate a moderate clinicopathologic concordance rate for skin biopsies in this setting, with considerable variability across disease categories and patient characteristics. The results underscore the continued importance of histopathological evaluation, particularly for diagnostically challenging dermatoses, and identify opportunities to improve diagnostic performance. The findings have practical implications for dermatology training by highlighting disease categories with low concordance and may serve as a quality-improvement metric to inform targeted continuing medical education programs aimed at enhancing diagnostic accuracy.