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Expert Second Opinions Up Reliability of Melanoma Diagnosis

In study, none of the second opinion strategies eliminated diagnostic misclassification

TUESDAY, Oct. 22, 2019 (HealthDay News) — Second opinions rendered by dermatopathologists improve the reliability of melanocytic lesion diagnosis, although there is still discordance among pathologists, according to a study published online Oct. 11 in JAMA Network Open.

Michael W. Piepkorn, M.D., Ph.D., from the University of Washington in Seattle, and colleagues examined the association of second-opinion strategies by general pathologists and dermatopathologists with the overall reliability of diagnosis of difficult melanocytic lesions. A total of 240 melanocytic lesion samples were examined independently by 187 U.S. pathologists: 113 general pathologists and 74 dermatopathologists.

The researchers found that physicians desired second opinions for 43.4 percent of the 8,976 initial case interpretations, most often for interpretation of severely dysplastic nevi. When interpretations did not include second opinions and initial reviewers were all general pathologists lacking subspecialty training, the overall misclassification rate was highest (52.8 percent). The misclassification of melanocytic lesions was lowest (36.7 percent) when the first, second, and third consulting reviewers were subspecialty-trained dermatopathologists and when all lesions were subject to second opinions. The reductions in misclassification rates for some of the strategies were statistically significant when the second opinion strategies were compared with single interpretations without second opinions; none of the strategies eliminated diagnostic misclassification. The highest misclassification rates were seen for melanocytic lesions in the middle of the diagnostic spectrum.

“A second opinion contributed by an expert may facilitate consensus about the appropriate management of a difficult melanocytic lesion,” the authors write.

One author disclosed financial ties to the molecular diagnostic industry; a second author disclosed ties to the publishing industry.

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