Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions: Policies, Practices, and Perceptions.

Publication Title

Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]

Authors

Berta M Geller
Paul D Frederick
Stevan R Knezevich
Jason P Lott
Heidi D Nelson, Providence Cancer Center, Providence Health and Services Oregon
Linda J Titus
Patricia A Carney
Anna N A Tosteson
Tracy L Onega
Raymond L Barnhill
Martin A Weinstock
David E Elder
Michael W Piepkorn
Joann G Elmore

Document Type

Article

Publication Date

2-1-2018

Keywords

Attitude of Health Personnel; Cross-Sectional Studies; Humans; Melanoma; Organizational Policy; Pathologists; Practice Patterns, Physicians'; Referral and Consultation; Skin Neoplasms; Surveys and Questionnaires

Abstract

BACKGROUND: Research examining the role of second opinions in pathology for diagnosis of melanocytic lesions is limited.

OBJECTIVE: To assess current laboratory policies, clinical use of second opinions, and pathologists' perceptions of second opinions for melanocytic lesions.

MATERIALS AND METHODS: Cross-sectional data collected from 207 pathologists in 10 US states who diagnose melanocytic lesions. The web-based survey ascertained pathologists' professional information, laboratory second opinion policy, use of second opinions, and perceptions of second opinion value for melanocytic lesions.

RESULTS: Laboratory policies required second opinions for 31% of pathologists and most commonly required for melanoma in situ (26%) and invasive melanoma (30%). In practice, most pathologists reported requesting second opinions for melanocytic tumors of uncertain malignant potential (85%) and atypical Spitzoid lesions (88%). Most pathologists perceived that second opinions increased interpretive accuracy (78%) and protected them from malpractice lawsuits (62%).

CONCLUSION: Use of second opinions in clinical practice is greater than that required by laboratory policies, especially for melanocytic tumors of uncertain malignant potential and atypical Spitzoid lesions. Quality of care in surgical interventions for atypical melanocytic proliferations critically depends on the accuracy of diagnosis in pathology reporting. Future research should examine the extent to which second opinions improve accuracy of melanocytic lesion diagnosis.

Clinical Institute

Cancer

Specialty/Research Institute

Pathology & Laboratory Medicine

Specialty/Research Institute

Oncology

Specialty/Research Institute

Dermatology