title: Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications.
abstract: BACKGROUND
  Histopathologic analysis remains the gold standard for the diagnosis of melanoma, however previous studies have shown a substantial rate of interobserver variability in the evaluation of melanocytic lesions.
  
  
  OBJECTIVE
  We sought to evaluate discordance in the histopathological diagnosis and microstaging parameters of melanoma and subsequent impact on clinical management.
  
  
  METHODS
  This was a retrospective review of 588 cases of cutaneous melanoma and melanoma in situ from January 2009 to December 2014 that were referred to Emory University Hospital, Atlanta, GA, for treatment. Per institutional policy, all outside melanoma biopsy specimens were reviewed internally. Outside and institutional reports were compared.
  
  
  RESULTS
  Disagreement between outside and internal reports resulted in a change in American Joint Committee on Cancer pathologic stage in 114/588 (19%) cases, resulting in a change in management based on National Comprehensive Cancer Network guidelines in 105/588 (18%) cases.
  
  
  CONCLUSIONS
  Given the retrospective nature of data collection and the bias of a tertiary care referral center, cases in this study may not be representative of all melanoma diagnoses.
  
  
  CONCLUSIONS
  These findings confirm consistent subjectivity in the histopathologic interpretation of melanoma. This study emphasizes that a review of the primary biopsy specimen may lead to significant changes in tumor classification, resulting in meaningful changes in clinical management.
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Samit
authors.initials: S
authors.lastname: Patrawala
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Maley
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Greskovich
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Stuart
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Douglas
authors.initials: D
authors.lastname: Parker
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Swerlick
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: bstoff@emory.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Stoff
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D015588:Observer Variation; D010338:Pathology, Clinical / Q000592:standards*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis; D014481:United States; D000096142:Cutaneous Malignant Melanoma
keywords: consensus; dermatopathology; discordance; melanoma; melanoma in situ; microstaging parameters; prognosis; second opinion