title: Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions: an interdisciplinary study on 107 cases.
abstract: BACKGROUND
  Dermoscopy (dermatoscopy, epiluminescence microscopy) is increasingly employed for the preoperative detection of cutaneous melanoma; dermoscopic features of pigmented skin lesions have been previously defined using histopathology as the key to the code. In a preliminary study on 10 cases evaluated by nine dermoscopists and nine histopathologists, the authors experienced that when at least two dermoscopists disagree in evaluating a melanocytic lesion, even histopathologic consultations may give equivocal results.
  
  
  METHODS
  One hundred seven melanocytic skin lesions, consecutively excised because of equivocal clinical and/or dermoscopic features, were retrospectively examined by eight dermoscopists and eight histopathologists; the diagnostic interobserver agreement was calculated by means of the Schouten k statistics. After histopathologic consultations, all 107 lesions underwent unblinded dermoscopic re-evaluation in order to find which dermoscopic features had given rise to histopathologic diagnostic difficulties.
  
  
  RESULTS
  The interobserver ageement was good for both dermoscopy (k = 0.53) and histopathology (k = 0.74). Out of 48 cases evaluated by the dermoscopists in complete accordance, only 8 (16.7%) received at least one conflicting histopathologic diagnosis. Instead, among the remaining 59 cases with at least one disagreeing dermoscopic diagnosis, 21 (35.6%) received at least one disagreeing histopathologic diagnosis. The unblinded dermoscopic re-evaluation showed that five out of seven lesions with clear-cut regression structures were histopathologically controversial.
  
  
  CONCLUSIONS
  At least for selected and reasonably difficult lesions, a diagnostic discrepancy among formally trained dermoscopists seems to be predictive for a diagnostic disagreement among histopathologists. Lesions showing clear-cut regression structures are prone to give some histopathologic disagreement.
authors.affiliation: Pathologic Anatomy and Histology Service, G. Rummo General Hospital, Benevento, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ferrara
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
authors.forename: Rosamaria
authors.initials: R
authors.lastname: Corona
authors.forename: Francesco
authors.initials: F
authors.lastname: Sera
authors.forename: Bruno
authors.initials: B
authors.lastname: Brunetti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cerroni
authors.forename: Sergio
authors.initials: S
authors.lastname: Chimenti
authors.forename: Laila
authors.initials: L
authors.lastname: El Shabrawi-Caelen
authors.forename: Angela
authors.initials: A
authors.lastname: Ferrari
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.forename: Steven
authors.initials: S
authors.lastname: Kaddu
authors.forename: Domenico
authors.initials: D
authors.lastname: Piccolo
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Scalvenzi
authors.forename: Stefania
authors.initials: S
authors.lastname: Staibano
authors.forename: Ingrid H
authors.initials: IH
authors.lastname: Wolf
authors.forename: Gaetano
authors.initials: G
authors.lastname: De Rosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003581:Cytodiagnosis / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008853:Microscopy; D008875:Middle Aged; D015588:Observer Variation; D011361:Professional Competence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology