title: Discordance in the histopathologic diagnosis of difficult melanocytic neoplasms in the clinical setting.
abstract: BACKGROUND
  The gold standard for diagnosing melanocytic neoplasms is by histopathologic examination. However, lack of agreement among expert dermatopathologists in evaluating these tumors has been well established in experimental settings.
  
  
  OBJECTIVE
  This study examines the discordance among dermatopathologists in evaluating difficult melanocytic neoplasms in a clinical setting where the diagnosis impacts patient management.
  
  
  METHODS
  Retrospective review of consultation reports over a 6-year period.
  
  
  RESULTS
  There was complete agreement among the consultants in 54.5% of the cases. However, a high level of disagreement was found in 25% of the cases.
  
  
  CONCLUSIONS
  The analysis was limited to two consultant dermatopathologists.
  
  
  CONCLUSIONS
  There are limitations to the practical applications of histologic criteria for diagnosing difficult melanocytic tumors. It is not malpractice for a pathologist to have rendered a diagnosis that did not predict clinical outcome as long as 'standard of care' has been followed in his/her evaluation of the specimen.
authors.affiliation: Department of Dermatology, Columbia University, New York, NY 10032, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Lodha
authors.forename: Sarika
authors.initials: S
authors.lastname: Saggar
authors.forename: Julide T
authors.initials: JT
authors.lastname: Celebi
authors.forename: David N
authors.initials: DN
authors.lastname: Silvers
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D009506:Nevus / Q000175:diagnosis* / Q000473:pathology; D015588:Observer Variation; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology