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Does Specialty Training in Dermatopathology Lead to More Severe Diagnoses?

Specialty training linked to increased tendency to diagnose atypical melanocytic proliferations as pT1a melanomas

By Dermsquared Editorial Team | November 08, 2023

WEDNESDAY, Nov. 8, 2023 -- Specialty training in dermatopathology is associated with an increased tendency to diagnose atypical melanocytic proliferations as pT1a melanomas, according to a study published online Nov. 8 in JAMA Dermatology.

Kathleen F. Kerr, Ph.D., from the University of Washington in Seattle, and colleagues conducted an exploratory study using data from two nationwide studies to identify pathologist characteristics associated with tendencies to diagnose melanocytic lesions as higher grade versus lower grade. A total of 338 pathologists were included: 113 general pathologists, 74 dermatopathologists from the Melanoma Pathology study, and 151 dermatopathologists from the Reducing Errors in Melanocytic Interpretations study.

The researchers found that specialist training in dermatopathology was the predominant factor associated with rendering more severe diagnoses. Compared with pathologists without this training, those with this training interpreting the same case were more likely to render higher-grade diagnoses and to diagnose invasive melanoma (odds ratios, 2.63 and 1.95, respectively). The observed difference in diagnosis of invasive melanoma was due to nonmitogenic pT1a diagnoses; when these lesions were grouped with the less severe diagnoses, no association was observed. Among dermatopathologists, higher-grade diagnoses were more likely to be assigned by those with a higher caseload of melanocytic lesions (odds ratio for trend, 1.27).

"We hypothesize that this could in part play a role in the rising incidence of early-stage melanoma with low risk of progression or patient morbidity, thereby contributing to increasing rates of overdiagnosis," the authors write.


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