Abstract
The diagnosis of cutaneous melanoma and melanocytic neoplasms in general is one of the most challenging fields in pathology, and the reported interobserver diagnostic agreement in the evaluation of melanocytic lesions is poor. Nevertheless, a correct histopathological diagnosis is crucial to ensure a good clinical management of the patients. The institution of multidisciplinary teams has recently modified the approach to the patients with cutaneous melanoma. Patients referred to a multidisciplinary melanoma unit after receiving a diagnosis of melanoma elsewhere are encouraged to have their histopathological diagnosis confirmed by a second opinion from the experienced pathologist of the team before any treatment is initiated. We performed a retrospective analysis on a series of 121 histopathological revisions required for melanocytic neoplasms in the context of a multidisciplinary team, in order to evaluate the effects of second diagnostic opinion (SDO) on the clinical management of the patients. We defined three types of diagnostic discrepancies between the first diagnosis and the second opinion, according to the greatness of their clinical impact. Overall, the incidence of diagnostic discrepancies of any type was quite high in our series (56%). Interestingly, the SDO determined relevant changes in the clinical management of the patients in 33 out of 121 (27.3%) cases. This study confirms that SDO by expert pathologists significantly affects the course of treatment of melanoma patients and helps improving the diagnostic accuracy and clinical outcome.
Highlights
Cutaneous melanoma (CM) is an aggressive tumor, with a 5-year survival rate of only 15–20% in advanced stage [1]
Original slides and paraffin-embedded tissue blocks from 130 melanocytic lesions were received for second diagnostic opinion (SDO) by the referral pathologists of the Melanoma Unit of University “Luigi Vanvitelli” (Naples, Italy), between November 2018 and February 2020
In the remaining 6 cases, a diagnostic agreement has been reached after a discussion between the two pathologists
Summary
Cutaneous melanoma (CM) is an aggressive tumor, with a 5-year survival rate of only 15–20% in advanced stage [1]. CM has a wide spectrum of histological mimickers and several benign and borderline melanocytic lesions with overlapping morphological features have to be considered in the differential diagnosis In this context, improvements have been reached in the last years in immunohistochemistry and molecular tests, in some specific diagnostic settings, including BAPomas, nevoid melanomas, and atypical spitzoid lesions. A second diagnostic opinion (SDO) from a pathologist with a high expertise in dermatopathology could improve the diagnostic accuracy in cases of melanocytic neoplasms firstly diagnosed by a general pathologist [11] In this context, the institution of multidisciplinary oncological teams brought about a revolution in CM patient management, and the convergence of dermatological and pathological skills allows to improve the accuracy of the diagnosis [11].
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