title: The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms.
abstract: BACKGROUND
  We tested the relevance of clinical information in the histopathologic evaluation of melanocytic skin neoplasm (MSN).
  
  
  METHODS
  Histopathologic specimens from 99 clinically atypical MSN were circulated among ten histopathologists; each case had clinical information available in a database with a five-step procedure (no information; age/sex/location; clinical diagnosis; clinical image; dermoscopic image); each step had a histopathologic diagnosis (D1 through D5); each diagnostic step had a level of diagnostic confidence (LDC) ranging from 1 (no diagnostic certainty) to 5 (absolute diagnostic certainty). The comparison of the LDC was employed with an analysis of variance (ANOVA) for repeated measures.
  
  
  RESULTS
  In D1 (no information), 36/99 cases (36.3%) had unanimous diagnosis; in D5 (full information available), 51/99 cases (51.5%) had unanimous diagnosis (p for difference between proportions <0.001). The observer agreement expressed as kappa increased significantly from D1 to D5. The mean LDC linearly increased for each observer from D1 through D5 (p for linear trend <0.001). On average, each histopathologist changed his initial diagnosis in 7 cases (range: 2-23). Most diagnostic changes were in D2 (age/sex/location).
  
  
  CONCLUSIONS
  The histopathologic criteria for the diagnosis of MSN can work as such, but the final histopathologic diagnosis is a clinically-aided interpretation. Clinical data sometimes reverse the initial histopathologic evaluation.
authors.affiliation: Department of Pathology, Gaetano Rummo General Hospital, Benevento, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ferrara
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Argenyi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Rino
authors.initials: R
authors.lastname: Cerio
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cerroni
authors.forename: Arturo
authors.initials: A
authors.lastname: Di Blasi
authors.forename: Elisa A A
authors.initials: EA
authors.lastname: Feudale
authors.forename: Caterina M
authors.initials: CM
authors.lastname: Giorgio
authors.forename: Cesare
authors.initials: C
authors.lastname: Massone
authors.forename: Oscar
authors.initials: O
authors.lastname: Nappi
authors.forename: Carlo
authors.initials: C
authors.lastname: Tomasini
authors.forename: Carmelo
authors.initials: C
authors.lastname: Urso
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Harald
authors.initials: H
authors.lastname: Kittler
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D016208:Databases, Factual; D046169:Dermoscopy / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D012878:Skin Neoplasms / Q000175:diagnosis*; D055815:Young Adult