title: Agreement on the clinical diagnosis and management of cutaneous squamous neoplasms.
abstract: BACKGROUND
  Diagnostic accuracy and preferred therapeutic strategies for actinic keratoses (AKs) and squamous cell carcinoma (SCC) have significant public health implications.
  
  
  OBJECTIVE
  To evaluate clinical-pathologic agreement on the diagnosis of AKs and early SCCs and to characterize the effect of diagnosis on therapeutic decisions.
  
  
  METHODS
  Nine dermatologists and two dermatopathologists reviewed an image-based dataset of AKs and early SCCs. Clinical-pathologic agreement, inter- and intraobserver reliability for clinical diagnosis, and frequencies of therapies according to pathologic diagnosis were assessed.
  
  
  RESULTS
  Clinical-pathologic (κ=0.10) agreement was poor, whereas interobserver (κ=0.24) and intraobserver (κ=0.28) agreements were fair. Participants were more likely to treat AKs with cryotherapy (64.2%) and to manage SCCs with surgery (72.8%). Therapeutic choice rarely changed after participants were shown histological photomicrographs. Participating clinicians treated most lesions histologically diagnosed as SCC in situ arising within AK using surgery, whereas pathologists selected cryotherapy or curettage and electrodesiccation for these lesions.
  
  
  CONCLUSIONS
  We found poor clinical-pathologic agreement and reproducibility for clinically distinguishing between AK and early SCC even between skin cancer specialists from a single academic group practice. Nomenclature used in the pathologic diagnosis of AK and SCC affects clinicians' therapeutic decisions. The authors have indicated no significant interest with commercial supporters.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Terushkin
authors.forename: Juliana C
authors.initials: JC
authors.lastname: Braga
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dusza
authors.forename: Alon
authors.initials: A
authors.lastname: Scope
authors.forename: Klaus
authors.initials: K
authors.lastname: Busam
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
authors.forename: Melissa
authors.initials: M
authors.lastname: Gill
authors.forename: Allan C
authors.initials: AC
authors.lastname: Halpern
mesh_terms: D000465:Algorithms; D000634:Aminoquinolines / Q000627:therapeutic use; D001706:Biopsy / Q000706:statistics & numerical data; D002278:Carcinoma in Situ / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy*; D003452:Cryosurgery / Q000706:statistics & numerical data; D003475:Curettage / Q000706:statistics & numerical data; D003880:Dermatology / Q000592:standards*; D003937:Diagnosis, Differential; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000473:pathology / Q000628:therapy; D015580:Mohs Surgery / Q000706:statistics & numerical data; D010778:Photochemotherapy; D011230:Precancerous Conditions / Q000473:pathology; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy*; D009626:Terminology as Topic; D014481:United States
chemical_list: D000634:Aminoquinolines; D000077271:Imiquimod; D005472:Fluorouracil