Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists

Farmer, Evan R.; Gonin, René; Hanna, Mark P.

doi:10.1016/s0046-8177(96)90157-4

Cited by 405 publications

(270 citation statements)

References 18 publications

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“…For example, desmoplastic and nevoid melanomas were not specifically excluded from the cohort, but none of the cases classified as either of these 2 particular melanoma subtypes received a triple‐concordant diagnosis by histopathology. The high frequency of discordance among reviewing dermatopathologists in this study was similar to that observed in other assessments of clinical cohorts3, 4, 5, 6, 7 and highlights the need for adjunctive diagnostic tools. An evaluation of the gene signature against clinical outcomes would minimize cohort bias toward straightforward cases, and studies assessing test performance by comparison with clinical outcomes are currently underway.…”

Section: Discussionsupporting

confidence: 83%

“…Although this method is adequate for many cases, evidence suggests that approximately 15% of lesions may be diagnostically ambiguous by histopathology 3, 4, 5. As a result, even experienced dermatopathologists disagree in some cases, with diagnostic discordance ranging from 15% to 38% according to the type of lesion 3, 4, 5, 6, 7. Consequently, adjuncts to histopathology have been sought to facilitate the accurate diagnosis of melanoma.…”

Section: Introductionmentioning

confidence: 99%

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An independent validation of a gene expression signature to differentiate malignant melanoma from benign melanocytic nevi

Clarke

Flake

Busam

et al. 2016

Cancer

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BACKGROUNDRecently, a 23‐gene signature was developed to produce a melanoma diagnostic score capable of differentiating malignant and benign melanocytic lesions. The primary objective of this study was to independently assess the ability of the gene signature to differentiate melanoma from benign nevi in clinically relevant lesions.METHODSA set of 1400 melanocytic lesions was selected from samples prospectively submitted for gene expression testing at a clinical laboratory. Each sample was tested and subjected to an independent histopathologic evaluation by 3 experienced dermatopathologists. A primary diagnosis (benign or malignant) was assigned to each sample, and diagnostic concordance among the 3 dermatopathologists was required for inclusion in analyses. The sensitivity and specificity of the score in differentiating benign and malignant melanocytic lesions were calculated to assess the association between the score and the pathologic diagnosis.RESULTSThe gene expression signature differentiated benign nevi from malignant melanoma with a sensitivity of 91.5% and a specificity of 92.5%.CONCLUSIONSThese results reflect the performance of the gene signature in a diverse array of samples encountered in routine clinical practice. Cancer 2017;123:617–628. © 2016 American Cancer Society.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

An independent validation of a gene expression signature to differentiate malignant melanoma from benign melanocytic nevi

Clarke

Flake

Busam

et al. 2016

Cancer

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“…The concordance in the diagnosis of spitzoid lesions within our group was very good (75%), although there was discordance in 25% of the cases, which is to be expected based on previous reports in the literature. 4,5 In contrast to other series in the literature, 25,40-46 we identified BRAF mutations in 10 Spitz nevi, five of which specimens had atypical histologic features such as architectural disorder, increased cytologic atypia, and/or inflammation. The somewhat underpowered sample size of our study of the group of 48 Spitz nevi does not permit firm conclusions to be drawn with respect to age and BRAF status; however, we did not appreciate any statistically significant differences by age.…”

Section: Discussioncontrasting

confidence: 73%

“…It is readily apparent that there may be a lack of consensus in the diagnosis of spitzoid lesions even among experts in this field. 3,4 Fortunately, most spitzoid lesions can be classified into benign Spitz nevi or Spitz-like melanomas based on published criteria. [5][6][7][8][9][10][11][12][13][14][15] However, a subset of spitzoid lesions remain that have histologic features that deviate from a typical Spitz nevus, yet are insufficient for a definitive diagnosis of Spitzlike melanoma.…”

mentioning

confidence: 99%

BRAF and NRAS mutations in spitzoid melanocytic lesions

et al. 2006

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BRAF mutations are common events in a variety of melanocytic nevi and primary cutaneous melanomas. We have previously found BRAF mutations in 82% of nevi, consisting of congenital, common acquired and dysplastic types, and 33% of primary cutaneous melanomas other than the spitzoid type, similar to other published reports. A small number of studies have evaluated Spitz nevi and have failed to detect any lesions possessing a BRAF mutation. Only one study included categories of atypical Spitz nevus and borderline lesions suspected to be spitzoid melanomas, along with classic Spitz nevi and spitzoid melanomas. We examined a spectrum of spitzoid lesions that included 48 Spitz nevi, some with atypical features, seven atypical (borderline) Spitz tumors, and 13 spitzoid melanomas. BRAF mutations were detected in 12 of 68 spitzoid lesions, of which two were spitzoid melanomas and 10 were Spitz nevi. Five of the 10 Spitz nevi with BRAF mutations were altered by more than usual cytologic atypia and/or architectural atypia overlapping with dysplastic nevi, or irritation/inflammation; one desmoplastic Spitz nevus had a BRAF mutation. These results indicate that a small subset of Spitz nevi, some with atypical histologic features, possess BRAF mutations. Therefore, the BRAF mutational status does not separate all Spitz nevi from spitzoid melanomas and non-Spitz types of melanocytic proliferations, contrary to previous reports.

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“…17,18 Various studies have shown that even expert melanocytic lesion pathologists are unable to obtain a concordant view on one-quarter to two-thirds of studied lesions. 19,20 These figures vary with the subset of melanocytic lesions under discussion, with the particularly treacherous Spitzoid melanomas and atypical Spitz's tumors generating the least consensus. 21 With respect to the latter, Barnhill et al 21 demonstrated a lack of consensus among members of an expert panel for 17 of 30 cases; 13 of 21 lesions held to be Spitz tumors metastasized.…”

Section: The Nature Of Error In Dermatopathological Practicementioning

confidence: 99%

Medicolegal aspects of neoplastic dermatology

Crowson

2006

Modern Pathology

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Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance. This, in turn, has had the real effect of denying care to patients in some communities in the US. Some 13% of all medical malpractice claims relate to one area of neoplastic dermatopathology, specifically, melanocytic neoplasia. Certain steps can be taken by pathology laboratories to reduce, but never completely eliminate, the risk of medical malpractice claims. In this review, attention is paid to the source of medical malpractice claims and an abbreviated approach to specific strategies for risk management is presented.

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Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists

Cited by 405 publications

References 18 publications

An independent validation of a gene expression signature to differentiate malignant melanoma from benign melanocytic nevi

An independent validation of a gene expression signature to differentiate malignant melanoma from benign melanocytic nevi

BRAF and NRAS mutations in spitzoid melanocytic lesions

Medicolegal aspects of neoplastic dermatology

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