Is Melanoma Suspected? Get 2nd Opinion From Specialist, Study Says

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FRIDAY, Oct. 11, 2019 (HealthDay News) — Melanoma is the most lethal type of skin cancer, and a new study finds that the diagnosis of a suspect lesion gains accuracy when a specialist pathologist is brought on board.

Many patients with melanoma are first diagnosed by general practitioners, dermatologists or plastic surgeons. A biopsy sample of the suspect lesion might then be sent to a general pathologist for further diagnosis, explained a team from the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA).

However, getting a second opinion from a pathologist specially trained in skin lesions — a dermatopathologist — yields the most accurate results, the new study found.

“A diagnosis is the building block on which all other medical treatment is based,” said study co-leader Dr. Joann Elmore, a professor of medicine and a researcher at the cancer center.

Her team noted that, of all pathology fields, analysis of biopsies for skin lesions and cancers has one of the highest rates of diagnostic errors. Those errors can affect the lives of millions of patients each year.

“On the other end of these biopsies are real patients: patients answering the late-night, anxiety-inducing phone calls when we inform them of their diagnosis; patients undergoing invasive surgeries; patients weighing their next clinical steps,” Elmore said in a UCLA news release.

“All patients deserve an accurate diagnosis. Unfortunately, the evaluation and diagnosis of skin biopsy specimens is challenging with a lot of variability among physicians,” she added.

Dr. Michele Green, a dermatologist at Lenox Hill Hospital in New York City, agreed.

“A diagnosis of skin cancer can be overwhelming,” said Green, who wasn’t involved in the new study. “It is imperative that patients know the training of the pathologist reviewing their specimen to ensure the accuracy of the diagnosis given.”

In their research, Elmore’s team found that getting a second opinion from pathologists who are board-certified, or have fellowship training in dermatopathology, can greatly boost the accuracy of a melanoma diagnosis.

The study included 187 pathologists — 113 general pathologists and 74 dermatopathologists — who examined 240 skin biopsy lesion samples. Misclassification rates of the lesions was lowest when first, second and third reviewers were subspecialty trained dermatopathologists.



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