title: The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions.
abstract: It is not known whether patient age or tumor characteristics such as tumor regression or solar elastosis influence pathologists' interpretation of melanocytic skin lesions (MSLs). We undertook a study to determine the influence of these factors, and to explore pathologist's characteristics associated with the direction of diagnosis. To meet our objective, we designed a cross-sectional survey study of pathologists' clinical practices and perceptions. Pathologists were recruited from diverse practices in 10 states in the United States. We enrolled 207 pathologist participants whose practice included the interpretation of MSLs. Our findings indicated that the majority of pathologists (54.6%) were influenced toward a less severe diagnosis when patients were <30 years of age. Most pathologists were influenced toward a more severe diagnosis when patients were >70 years of age, or by the presence of tumor regression or solar elastosis (58.5%, 71.0%, and 57.0%, respectively). Generally, pathologists with dermatopathology board certification and/or a high caseload of MSLs were more likely to be influenced, whereas those with more years' experience interpreting MSL were less likely to be influenced. Our findings indicate that the interpretation of MSLs is influenced by patient age, tumor regression, and solar elastosis; such influence is associated with dermatopathology training and higher caseload, consistent with expertise and an appreciation of lesion complexity.
authors.affiliation: Department of Epidemiology and Pediatrics, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Titus
authors.affiliation: Department of Pathology, Institut Curie and Faculty of Medicine, University of Paris Descartes, Paris, France.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Cornell-Scott Hill Health Center, New Haven, CT, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Lott
authors.affiliation: Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.|Dermatopathology Northwest, Bellevue, WA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Piepkorn
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.affiliation: Providence Cancer Center, Providence Health and Services, Portland, OR, USA.|Department of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: Pathology Associates, Clovis, CA, USA.
authors.forename: Stevan R
authors.initials: SR
authors.lastname: Knezevich
authors.affiliation: Center for Dermatoepidemiology, VA Medical Center, Providence, Department of Dermatology, Rhode Island Hospital, Providence, RI, USA.|Department of Dermatology and Epidemiology, Brown University, Providence, RI, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D015999:Multivariate Analysis; D000072142:Pathologists; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012867:Skin / Q000473:pathology*; D015595:Skin Aging / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis*; D014481:United States