Second Diagnostic Opinion by Experienced Dermatopathologists in the Setting of a Referral Regional Melanoma Unit Significantly Improves the Clinical Management of Patients With Cutaneous Melanoma

Frontiers in Medicine

Roberto Alfano¹  Giuseppe Signoriello²  Giuseppe Argenziano³  Gabriella Brancaccio³  Elvira Moscarella³  Andrea Ronchi⁴  Francesca Pagliuca⁴  Federica Zito Marino⁴  Renato Franco⁴ 

[1]Department of Anaesthesiology, Surgery and Emergency, University of Campania “Luigi Vanvitelli,”, Naples, Italy

[2]Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy

[3]Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy

[4]Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli,”, Naples, Italy

关键词: melanoma;    second diagnostic opinion;    diagnostic agreement;    clinical management;    caseload;    melanocytic neoplasms;   

DOI  :  10.3389/fmed.2020.568946

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY