Accuracy of Pathology Diagnosis of Melanoma

Our paper this month comes from Elmore et al, published in the BMJ. The authors set out to determine the accuracy and reproducibility of pathology diagnosis of melanocytic skin lesions. The study was done across the USA and included 240 skin biopsies, and almost 200 pathologists viewed the slides twice, eight months apart.

The accuracy of pathology diagnosis was high for nevi (92%) and invasive melanoma (72%) but was low for different types of atypia and early invasive melanoma (25-43%). Reproducibility was similar – higher for nevus and invasive melanoma, and lower for others.

These results highlight similar ones from other studies. Diagnosis of melanocytic skin lesions by pathology is hard. It is not “black and white” and so pathology diagnosis is not the gold standard.

GPs need to be aware of and thoughtful about these diagnostic challenges, and not blindly accept a pathology results as “the answer”.

Read the full paper here.

Professor David Wilkinson


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