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

Abstract

The diagnosis of cutaneous melanoma and melanocytic neoplasms in general is one of the most challenging fields in pathology, and the reported interobserver diagnostic agreement in the evaluation of melanocytic lesions is poor. Nevertheless, a correct histopathological diagnosis is crucial to ensure a good clinical management of the patients. The institution of multidisciplinary teams has recently modified the approach to the patients with cutaneous melanoma. Patients referred to a multidisciplinary melanoma unit after receiving a diagnosis of melanoma elsewhere are encouraged to have their histopathological diagnosis confirmed by a second opinion from the experienced pathologist of the team before any treatment is initiated. We performed a retrospective analysis on a series of 121 histopathological revisions required for melanocytic neoplasms in the context of a multidisciplinary team, in order to evaluate the effects of second diagnostic opinion (SDO) on the clinical management of the patients. We defined three types of diagnostic discrepancies between the first diagnosis and the second opinion, according to the greatness of their clinical impact. Overall, the incidence of diagnostic discrepancies of any type was quite high in our series (56%). Interestingly, the SDO determined relevant changes in the clinical management of the patients in 33 out of 121 (27.3%) cases. This study confirms that SDO by expert pathologists significantly affects the course of treatment of melanoma patients and helps improving the diagnostic accuracy and clinical outcome.

Impact of review of histopathology specimens at a tertiary oncology hospital in Eastern India – lessons learnt

“…In skin tumours, most frequent diagnostic discrepancy was encountered in pigmented or melanocytic lesions. This is similar to results from Italian authors who found diagnostic discrepancies in whopping 56% cases of melanomas and relevant treatment changes in 27.3% cases [ 16 ]. An aneurysmal fibrous histiocytoma was misdiagnosed as malignant melanoma with a pT4 stage.…”

The Challenge of Melanocytic Lesions in Pediatric Patients: Clinical-Pathological Findings and the Diagnostic Value of PRAME

“…In this setting, the histological diagnosis of spitzoid neoplasms is one of the most difficult issues in dermatopathology. Despite a better understanding of the molecular biology underlying these neoplasms, the differential diagnosis between benign lesions and malignant lesions is still difficult, and largely based on qualitative and albeit, partially subjective findings (11). PRAME has recently emerged as a novel immunohistochemical marker able to distinguish benign from malignant melanocytic proliferations (20).…”

“…However, the diagnosis still relies on histological examination, and the differential diagnosis in pediatric patients mainly includes Spitz nevus, atypical Spitz tumors, and Spitz melanoma. Histological diagnosis of melanocytic proliferations is certainly a challenge, as it mainly relies on morphological findings, which are almost partially subjective and requires trained pathologists with specific expertise (11). Recently, immunohistochemical and molecular biomarkers have been applied to the differential diagnosis, and have improved the diagnostic specificity.…”

Critical Considerations for Investigating MicroRNAs during Tumorigenesis: A Case Study in Conceptual and Contextual Nuances of miR-211-5p in Melanoma

“…The assessment of pigmented lesions is a notoriously challenging practice with documented high inter-observer and intra-observer discordance rates [ 83 , 84 ]. Acquiring additional diagnostic opinions from dermatopathologists significantly improves concordance [ 85 ]. Studies dissecting the genetic progression of melanoma have used teams of five or more dermatopathologists and documented their consensus (or lack thereof) diagnosis for each specimen to attenuate this confounding factor in cohort assembly [ 86 ].…”