Get a 2nd — and 3rd — opinion: 1 in 6 melanoma diagnoses could be wrong

Thursday, 06 July, 2017

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When it comes to a melanoma diagnosis, it’s worth getting a second — or third — opinion.

Accurately diagnosing skin cancer is challenging pathologists to the point where more than one in six melanoma diagnoses could be wrong. Concerns over the accuracy of melanoma diagnoses have been raised in a study of US pathologists published by The BMJ.

The study was inspired by a researcher’s experience as a patient undergoing a skin biopsy, which resulted in three different independent interpretations, ranging from benign to invasive melanoma. A decade later, Professor Joann Elmore of the University of Washington School of Medicine in Seattle is healthy and overseeing research on the topic.

Previous studies have suggested high levels of diagnostic disagreement among pathologists when interpreting melanocytic lesions, but results were conflicting. So Dr Elmore, with a team of researchers, set out to measure the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.

The results showed that diagnoses can vary among pathologists, particularly for cases in the middle of the disease spectrum, suggesting the potential for both over- and under-diagnosis.

Melanoma is a type of skin cancer that develops from skin cells called melanocytes. Diagnosis relies on visual assessment of skin samples (biopsies) under a microscope by a pathologist, but the reliability of the criteria used to diagnose these skin lesions have never been established with rigorous standards.

The study had 187 practising pathologists from 10 US states independently interpret the same set of skin biopsy cases on two separate occasions (phases 1 and 2), at least eight months apart.

Each case had been independently reviewed by a panel of three experienced skin pathologists and a consensus reference diagnosis reached.

The results showed that diagnoses ranging from moderately atypical lesions to early-stage invasive melanoma were neither accurate nor reproducible.

The study concluded that efforts to improve clinical practice should include use of a standardised classification format, acknowledging uncertainty of specific diagnoses in pathology reports and development of more sophisticated diagnostic tools to support pathologists.

Image credit: © Gretka

Originally published here.

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