title: The MPATH-Dx reporting schema for melanocytic proliferations and melanoma.
abstract: BACKGROUND
  The histologic diagnosis of melanoma and nevi can be subject to discordance and errors, potentially leading to inappropriate treatment and harm. Diagnostic terminology is not standardized, creating confusion for providers and patients and challenges for investigators.
  
  
  OBJECTIVE
  We sought to describe the development of a pathology reporting form for more precise research on melanoma and a diagnostic-treatment mapping tool for improved patient care and consistency in treatment.
  
  
  METHODS
  Three dermatopathologists independently reviewed melanocytic lesions randomly selected from a dermatopathology database. Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) reporting schema evolved from iterative case review and form revision.
  
  
  RESULTS
  Differences in diagnostic thresholds, interpretation, and nomenclature contributed to development of the MPATH-Dx histology reporting form, which groups lesions by similarities in histogenesis and degrees of atypia. Because preliminary results indicate greater agreement regarding suggested treatments than for specific diagnoses, the diverse terminologies of the MPATH-Dx histology reporting form were stratified by commonalities of treatments in the MPATH-Dx diagnostic-treatment mapping scheme.
  
  
  CONCLUSIONS
  Without transformative advances in diagnostic paradigms, the interpretation of melanocytic lesions frequently remains subjective.
  
  
  CONCLUSIONS
  The MPATH-Dx diagnostic-treatment mapping scheme could diminish confusion for those receiving reports by categorizing diverse nomenclature into a hierarchy stratified by suggested management interventions.
authors.affiliation: Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington. Electronic address: mpiepkor@uw.edu.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Piepkorn
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.affiliation: Veterans Affairs Medical Center, Seattle, Washington.
authors.forename: Stevan R
authors.initials: SR
authors.lastname: Knezevich
authors.affiliation: Department of Family Medicine, Oregon Health Sciences University, Portland, Oregon.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Reisch
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D008545:Melanoma / Q000473:pathology* / Q000628:therapy; D009508:Nevus, Pigmented / Q000473:pathology* / Q000628:therapy; D015588:Observer Variation; D011996:Records; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D009626:Terminology as Topic
keywords: AJCC; American Joint Committee on Cancer; BI-RADS; Breast Imaging-Reporting and Data System; MPATH-Dx; Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis; diagnosis; diagnostic errors; discordance; dysplasia; melanoma; nevi; observer variability