Histologic review of melanomas by pathologists trained in melanocytic lesions may change therapeutic approach in up to 41.9% of cases

Abstract

Melanoma Guidelines of the Brazilian Dermatology Society recommend histologic review by pathologists trained in melanocytic lesions whenever possible. Out of 145 melanoma cases identified at a private clinic in São Paulo/Brazil, 31 that had been submited to histologic review were studied to evaluate whether revision had led to change in therapeutic approach.. Differences in original/reviewed reports were found in 58.1% (n=18) of the reports, leading to changes in therapeutic approach in 41.9% (n=13). Change in diagnosis was observed in 6 out of 31 (19,3%) cases. These findings suggest that second opinion by pathologists trained in melanocytic lesions is likely to show significant differences from the original report.

Second Diagnostic Opinion by Experienced Dermatopathologists in the Setting of a Referral Regional Melanoma Unit Significantly Improves the Clinical Management of Patients With Cutaneous Melanoma

“…The role of the SDO in melanocytic pathology is poorly defined, and only few studies to date have focused on its impact on the clinical management of the patients. Suzuki NM et al analyzed a Series of 31 melanocytic lesions submitted to a SDO ( 17 ). The Authors found that the final diagnosis was radically changed by the second opinion in 19% (6 out of 31) of the cases, while a therapeutic approach was changed by the second opinion in 42% (13 out of 31) of the cases ( 17 ).…”

“…Suzuki NM et al analyzed a Series of 31 melanocytic lesions submitted to a SDO ( 17 ). The Authors found that the final diagnosis was radically changed by the second opinion in 19% (6 out of 31) of the cases, while a therapeutic approach was changed by the second opinion in 42% (13 out of 31) of the cases ( 17 ). Gaudi et al investigated the discrepancies between first diagnoses and SDOs in 405 cases assigned into 1 of 4 categories: melanocytic neoplasm, non-melanocytic neoplasm, inflammatory, and other.…”

The Implications of a Dermatopathologist’s Report on Melanoma Diagnosis and Treatment

“…Imprecise or incomplete histopathologic reports of melanocytic lesions can have far-reaching consequences, potentially leading to inappropriate treatment recommendations and misguided decisions regarding follow-up care for melanoma patients. Beyond the obvious medico-legal implications, the consequences of such errors in surgical treatment can significantly compromise patient outcomes [ 6 , 10 , 12 , 15 , 16 , 17 , 26 , 29 ].…”

“…Pathologists experienced in this specialized field possess in-depth knowledge of the morphologic characteristics of melanocytic lesions and are familiar with the subtle nuances that differentiate benign lesions from malignant ones. Their expertise allows for accurate measurement and interpretation and precise reporting of an accurate T-stage for invasive melanomas [ 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 27 , 28 , 29 , 30 ]. An inaccurate diagnosis may lead to inadequate estimation of the recurrence risk and thus to over- or under-treatment [ 6 , 10 , 12 , 13 , 15 , 16 , 29 ].…”

“…Their expertise allows for accurate measurement and interpretation and precise reporting of an accurate T-stage for invasive melanomas [ 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 25 , 26 , 27 , 28 , 29 , 30 ]. An inaccurate diagnosis may lead to inadequate estimation of the recurrence risk and thus to over- or under-treatment [ 6 , 10 , 12 , 13 , 15 , 16 , 29 ]. Therefore, a review of melanoma biopsy specimens by an expert dermatopathologist in pigmented lesions is a common practice in several tertiary care referral centers in the world, in an effort to reduce the risk of misdiagnosis, reduce the deviation of staging and to facilitate the optimal management of patients diagnosed with primary cutaneous melanoma [ 6 , 10 , 12 , 15 , 16 , 29 , 31 , 32 , 33 ].…”