Berta M Geller1, Paul D Frederick2, Stevan R Knezevich3, Jason P Lott4, Heidi D Nelson5, Linda J Titus6, Patricia A Carney7, Anna N A Tosteson8, Tracy L Onega9,10, Raymond L Barnhill11, Martin A Weinstock12, David E Elder13, Michael W Piepkorn14,15, Joann G Elmore2. 1. Department of Family Medicine, College of Medicine, University of Vermont, Burlington, Vermont. 2. Department of Medicine, University of Washington School of Medicine, Seattle, Washington. 3. Pathology Associates, Clovis, California. 4. Dermatology, Bayer Healthcare LLC, Whippany, New Jersey. 5. Providence Cancer Center, Providence Health and Services Oregon, and Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health and Science University, Portland, Oregon. 6. Departments of Epidemiology and Pediatrics, Geisel School of Medicine at Dartmouth and the Norris Cotton Cancer Center, Lebanon, New Hampshire. 7. Departments of Family Medicine and Public Health and Preventative Medicine, Oregon Health and Science University, Portland, Oregon. 8. Department of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. 9. Departments of Biomedical Data Science, and. 10. Epidemiology, Norris Cotton Cancer Center, Lebanon, New Hampshire. 11. Department of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France. 12. Center for Dermatoepidemiology, VA Medical Center, Providence Department of Dermatology, Rhode Island Hospital Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island. 13. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 14. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington. 15. Dermatopathology Northwest, Bellevue, Washington.
Abstract
BACKGROUND: Research examining the role of second opinions in pathology for diagnosis of melanocytic lesions is limited. OBJECTIVE: To assess current laboratory policies, clinical use of second opinions, and pathologists' perceptions of second opinions for melanocytic lesions. MATERIALS AND METHODS: Cross-sectional data collected from 207 pathologists in 10 US states who diagnose melanocytic lesions. The web-based survey ascertained pathologists' professional information, laboratory second opinion policy, use of second opinions, and perceptions of second opinion value for melanocytic lesions. RESULTS: Laboratory policies required second opinions for 31% of pathologists and most commonly required for melanoma in situ (26%) and invasive melanoma (30%). In practice, most pathologists reported requesting second opinions for melanocytic tumors of uncertain malignant potential (85%) and atypical Spitzoid lesions (88%). Most pathologists perceived that second opinions increased interpretive accuracy (78%) and protected them from malpractice lawsuits (62%). CONCLUSION: Use of second opinions in clinical practice is greater than that required by laboratory policies, especially for melanocytic tumors of uncertain malignant potential and atypical Spitzoid lesions. Quality of care in surgical interventions for atypical melanocytic proliferations critically depends on the accuracy of diagnosis in pathology reporting. Future research should examine the extent to which second opinions improve accuracy of melanocytic lesion diagnosis.
BACKGROUND: Research examining the role of second opinions in pathology for diagnosis of melanocytic lesions is limited. OBJECTIVE: To assess current laboratory policies, clinical use of second opinions, and pathologists' perceptions of second opinions for melanocytic lesions. MATERIALS AND METHODS: Cross-sectional data collected from 207 pathologists in 10 US states who diagnose melanocytic lesions. The web-based survey ascertained pathologists' professional information, laboratory second opinion policy, use of second opinions, and perceptions of second opinion value for melanocytic lesions. RESULTS: Laboratory policies required second opinions for 31% of pathologists and most commonly required for melanoma in situ (26%) and invasive melanoma (30%). In practice, most pathologists reported requesting second opinions for melanocytic tumors of uncertain malignant potential (85%) and atypical Spitzoid lesions (88%). Most pathologists perceived that second opinions increased interpretive accuracy (78%) and protected them from malpractice lawsuits (62%). CONCLUSION: Use of second opinions in clinical practice is greater than that required by laboratory policies, especially for melanocytic tumors of uncertain malignant potential and atypical Spitzoid lesions. Quality of care in surgical interventions for atypical melanocytic proliferations critically depends on the accuracy of diagnosis in pathology reporting. Future research should examine the extent to which second opinions improve accuracy of melanocytic lesion diagnosis.
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Authors: Kathleen F Kerr; Gary M Longton; Lisa M Reisch; Andrea C Radick; Megan M Eguchi; Hannah L Shucard; Margaret S Pepe; Michael W Piepkorn; David E Elder; Raymond L Barnhill; Joann G Elmore Journal: Clin Exp Dermatol Date: 2022-06-22 Impact factor: 4.481
Authors: Michael W Piepkorn; Gary M Longton; Lisa M Reisch; David E Elder; Margaret S Pepe; Kathleen F Kerr; Anna N A Tosteson; Heidi D Nelson; Stevan Knezevich; Andrea Radick; Hannah Shucard; Tracy Onega; Patricia A Carney; Joann G Elmore; Raymond L Barnhill Journal: JAMA Netw Open Date: 2019-10-02