Prior knowledge of the clinical picture does not introduce bias in the histopathologic diagnosis of melanocytic skin lesions.
A common debate among dermatopathologists is that prior knowledge of the clinical picture of melanocytic skin neoplasms may introduce a potential bias in the histopathologic examination. Histologic slides from 99 melanocytic skin neoplasms were circulated among 10 clinical dermatologists, all of them formally trained and board-certified dermatopathologists: 5 dermatopathologists had clinical images available after a 'blind' examination (Group 1); the other 5 had clinical images available before microscopic examination (Group 2). Data from the two groups were compared regarding 'consensus' (a diagnosis in agreement by ≥4 dermatopathologists/group), chance-corrected interobserver agreement (Fleiss' k) and level of diagnostic confidence (LDC: a 1-5 arbitrary scale indicating 'increasing reliability' of any given diagnosis). Compared with Group 1 dermatopathologists, Group 2 achieved a lower number of consensus (84 vs. 90) but a higher k value (0.74 vs. 0.69) and a greater mean LDC value (4.57 vs. 4.32). The same consensus was achieved by the two groups in 81/99 cases. Spitzoid neoplasms were most frequently controversial for both groups. The histopathologic interpretation of melanocytic neoplasms seems to be not biased by the knowledge of the clinical picture before histopathologic examination.
Anatomic Pathology Unit, Gaetano Rummo General Hospital, Benevento, Italy.
Gerardo
G
Ferrara
Dermatopathology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy.
Giorgio
G
Annessi
Department of Dermatology, University of Washington, Seattle, Seattle, WA, USA.
Zsolt
Z
Argenyi
Department of Dermatology, Second University of Naples, Naples, Italy.
Giuseppe
G
Argenziano
Department of Dermatology, Inselspital - Bern University Hospital, Bern, Switzerland.
Helmut
H
Beltraminelli
Department of Dermatology, University of London, London, UK.
Rino
R
Cerio
Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria.
Lorenzo
L
Cerroni
Dermatopathology Unit, San Galligano Dermatological Institute, Rome, Italy.
Carlo
C
Cota
Department of Dermatology, Ospedale Santa Maria della Misericordia, Perugia, Italy.
Stefano
S
Simonetti
Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
Catherine M
CM
Stefanato
Department of Dermatology, Medical University of Graz, Graz, Austria.
Iris
I
Zalaudek
Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria.
Harald
H
Kittler
Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia.
H Peter
HP
Soyer
clinical information; clinicopathologic correlation; dermoscopy; histopathologic diagnosis; melanocytic skin neoplasms