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Multiple pathologists may aid in diagnosing challenging melanocytic tumors

Diagnoses were changed upon review by a second pathologist in more than one-third of diagnostically challenging melanocytic tumors in a recent cohort, according to study results.

The current study investigates patients treated at the Massachusetts General Hospital Pigmented Lesion Clinic who presented with diagnostically challenging melanocytic tumors. To determine the frequency of such cases, researchers evaluated referral materials for changes in diagnosis upon review. Specifically, they required findings demonstrating differences in diagnosis and in therapeutic impact.

There were 478 consecutive cutaneous melanocytic tumors evaluated in the analysis. There were 126 from 1996-1997 and 352 from 2010-2011.

Changes in diagnoses occurred in 168 of 478 cases (35%), according to the results. The changes occurred more frequently when the original diagnostician was a general pathologist (P=.003).

Both cohorts demonstrated a similar proportion of diagnoses that were changed from malignant to benign or vice versa.

“Changes in stage or grading led to the most changes in therapy [78%; 50/64] versus changes from benign to malignant or vice versa [22%; 14/64],” the researchers wrote.

The researchers concluded that patients presenting with this subset of melanocytic tumors should be reviewed by more than one pathologist.