Faculty Collaboration Database

Incorporation of dermoscopy improves inter-observer agreement among dermatopathologists in histologic assessment of melanocytic neoplasms. Arch Dermatol Res 2021 Mar;313(2):101-108

Date

04/28/2020

Pubmed ID

32338293

DOI

10.1007/s00403-020-02079-w

Scopus ID

2-s2.0-85084205091 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

Histopathologic assessment of melanocytic neoplasms is the current gold standard of diagnosis. However, there are well recognized limitations including inter-observer diagnostic discordance. This study aimed to determine if integrating dermoscopy with histopathology of melanocytic neoplasms impacts diagnosis and improves inter-observer agreement. We conducted a prospective cohort study in a pigmented lesion clinic. Consecutive melanocytic lesions were identified for biopsy based on atypical gross or dermoscopic features. Standardized immunohistochemistry and levels were ordered on each specimen. The cases were randomized. Three dermatopathologists blinded to the clinical impression assessed each lesion. The cases were then re-randomized and re-assessed with addition of gross clinical and dermoscopic images. Inter-rater reliability (IRR) using Fleiss' kappa statistic revealed an increase from 0.447 without to 0.496 with dermoscopy amongst all dermatopathologists. The kappa increased from 0.495 before to 0.511 with dermoscopy in separating high-grade atypia or melanoma from moderate atypia or less. In 16 of 136 cases, at least 2 of 3 dermatopathologists favored a diagnosis of melanoma only after dermoscopy. In total, the consensus grade of atypia changed in 24.3% (33/ 136) of cases thereby representing changes to excisional margins and patient follow up. This study is limited by the cohort size. Dermoscopy significantly impacts diagnosis and improves identification of early melanomas in high risk populations and improves inter-observer agreement.

Author List

Shi K, Compres E, Walton KE, Mohan LS, Zhang B, Panah E, Quan VL, Garfield EM, Khan AU, Kim D, Yazdan P, Robinson JK, Gerami P

Author

Kara E. Young MD Associate Professor in the Dermatology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biopsy
Consensus
Dermoscopy
Diagnosis, Differential
Feasibility Studies
Female
Humans
Immunohistochemistry
Male
Margins of Excision
Melanoma
Middle Aged
Nevus, Pigmented
Observer Variation
Pathologists
Prospective Studies
Reproducibility of Results
Skin
Skin Neoplasms
Young Adult