Skip to main content

Advertisement

SpringerLink
Log in

Incorporation of dermoscopy improves inter-observer agreement among dermatopathologists in histologic assessment of melanocytic neoplasms

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Histopathologic assessment of melanocytic neoplasms is the current gold standard of diagnosis. However, there are well recognized limitations including inter-observer diagnostic discordance. This study aimed to determine if integrating dermoscopy with histopathology of melanocytic neoplasms impacts diagnosis and improves inter-observer agreement. We conducted a prospective cohort study in a pigmented lesion clinic. Consecutive melanocytic lesions were identified for biopsy based on atypical gross or dermoscopic features. Standardized immunohistochemistry and levels were ordered on each specimen. The cases were randomized. Three dermatopathologists blinded to the clinical impression assessed each lesion. The cases were then re-randomized and re-assessed with addition of gross clinical and dermoscopic images. Inter-rater reliability (IRR) using Fleiss’ kappa statistic revealed an increase from 0.447 without to 0.496 with dermoscopy amongst all dermatopathologists. The kappa increased from 0.495 before to 0.511 with dermoscopy in separating high-grade atypia or melanoma from moderate atypia or less. In 16 of 136 cases, at least 2 of 3 dermatopathologists favored a diagnosis of melanoma only after dermoscopy. In total, the consensus grade of atypia changed in 24.3% (33/ 136) of cases thereby representing changes to excisional margins and patient follow up. This study is limited by the cohort size. Dermoscopy significantly impacts diagnosis and improves identification of early melanomas in high risk populations and improves inter-observer agreement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Abbreviations

IRR:

Inter-rater reliability

IHC:

Immunohistochemistry

H&E:

Hematoxylin and Eosin

DP:

Dermatopathologist

References

  1. Patrawala S, Maley A, Greskovich C, Stuart L, Parker D, Swerlick R et al (2016) Discordance of histopathologic parameters in cutaneous melanoma: Clinical implications. J Am Acad Dermatol 74(1):75–80

    Article  Google Scholar 

  2. Shoo BA, Sagebiel RW, Kashani-Sabet M (2010) Discordance in the histopathologic diagnosis of melanoma at a melanoma referral center. J Am Acad Dermatol 62(5):751–756

    Article  Google Scholar 

  3. Urso C, Rongioletti F, Innocenzi D, Batolo D, Chimenti S, Fanti PL et al (2005) Histological features used in the diagnosis of melanoma are frequently found in benign melanocytic naevi. J Clin Pathol 58(4):409–412

    Article  CAS  Google Scholar 

  4. Gonzalez ML, Young ED, Bush J, McKenzie K, Hunt E, Tonkovic-Capin V et al (2017) Histoapthologic features of melanoma in difficult-to-diagnose lesions: A case-control study. J Am Acad Dermatol 77(3):543–548

    Article  Google Scholar 

  5. Ferrara G, Argenyi Z, Argenziano G, Cerio R, Cerroni L, Di Blasi A et al (2009) The influence of clinical information in the histopathologic diagnosis of melanocytic skin neoplasms. PLoS ONE 4(4):e5375

    Article  Google Scholar 

  6. Cabete J, Lencastre A, João A (2016) Combined use of ex vivo dermoscopy and histopathology for the diagnosis of melanocytic tumors. Am J Dermatopathol 38(3):189–193

    Article  Google Scholar 

  7. Merkel EA, Amin SM, Lee CY, Rademaker AW, Yazdan P, Martini MC et al (2016) The utility of dermoscopy-guided histologic sectioning for the diagnosis of melanocytic lesions: A case-control study. J Am Acad Dermatol 74(6):1107–1113

    Article  Google Scholar 

  8. Filosa A, Filosa G (2018) Melanoma diagnosis: The importance of histopathological report. Dermatopathology (Basel) 5(1):41–43

    Article  Google Scholar 

  9. Fuertes L, Santonja C, Kutzner H, Requena L (2016) Immunohistochemistry in dermatopathology: A retrospective study of the most frequently used antibodies. Am J Dermatopathol 38(2):92–104

    Article  Google Scholar 

  10. Abbas O, Miller DD, Bhawan J (2014) Cutaneous malignant melanoma: update on diagnostic and prognostic biomarkers. Am J Dermatopathol 36(5):363–379

    Article  Google Scholar 

  11. Bauer J, Leinweber B, Metzler G, Blum A, Hofmann-Wellenhof R, Leitz N et al (2006) Correlation with digital dermoscopic images can help dermatopathologists to diagnose equivocal skin tumours. Br J Dermatol 155(3):546–551

    Article  CAS  Google Scholar 

  12. Fleiss JL (1971) Measuring nominal scale agreement among many raters. Psychol Bull 76(5):378–382

    Article  Google Scholar 

  13. Team RC (2013) R: a language and environment for statistical computing. https://www.R-project.org/. Accessed 5 Sept 2018

  14. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  Google Scholar 

  15. Hawryluk EB, Sober AJ, Piris A, Nazarian RM, Hoang MP, Tsao H et al (2012) Histologically challenging melanocytic tumors referred to a tertiary care pigmented lesion clinic. J Am Acad Dermatol 67(4):727–735

    Article  Google Scholar 

  16. Lodha S, Saggar S, Celebi JT, Silvers DN (2008) Discordance in the histopathologic diagnosis of difficult melanocytic neoplasms in the clinical setting. J Cutan Pathol 35(4):349–352

    Article  Google Scholar 

  17. Farmer ER, Gonin R, Hanna MP (1996) Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists. Hum Pathol 27(6):528–531

    Article  CAS  Google Scholar 

  18. Brochez L, Verhaeghe E, Grosshans E, Haneke E, Piérard G, Ruiter D et al (2002) Inter-observer variation in the histopathological diagnosis of clinically suspicious pigmented skin lesions. J Pathol 196(4):459–466

    Article  Google Scholar 

  19. Piepkorn MW, Barnhill RL, Cannon-Albright LA, Elder DE, Goldgar DE, Lewis CM et al (1994) A multiobserver, population-based analysis of histologic dysplasia in melanocytic nevi. J Am Acad Dermatol 30(5 Pt 1):707–714

    Article  CAS  Google Scholar 

  20. Rhodes AR, Mihm MC Jr, Weinstock MA (1989) Dysplastic melanocytic nevi: a reproducible histologic definition emphasizing cellular morphology. Mod Pathol 2(4):306–319

    CAS  PubMed  Google Scholar 

  21. Hastrup N, Clemmensen OJ, Spaun E, SØndergaard K (1994) Dysplastic naevus: histological criteria and their inter-observer reproducibility. Histopathology 24(6):503–509

    Article  CAS  Google Scholar 

  22. Corona R, Mele A, Amini M, De Rosa G, Coppola G, Piccardi P et al (1996) Interobserver variability on the histopathologic diagnosis of cutaneous melanoma and other pigmented skin lesions. J Clin Oncol 14(4):1218–1223

    Article  CAS  Google Scholar 

  23. Ferrara G, Argenziano G, Soyer HP, Corona R, Sera F, Brunetti B et al (2002) Dermoscopic and histopathologic diagnosis of equivocal melanocytic skin lesions: an interdisciplinary study on 107 cases. Cancer 95(5):1094–1100

    Article  Google Scholar 

  24. Binder M, Schwarz M, Winkler A, Steiner A, Kaider A, Wolff K et al (1995) Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol 131(3):286–291

    Article  CAS  Google Scholar 

  25. Vestergaard ME, Macaskill P, Holt PE, Menzies SW (2008) Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol 159(3):669–676

    CAS  PubMed  Google Scholar 

  26. Heenan PJ, Matz LR, Blackwell JB, Kelsall GR, Singh A, ten Seldam RE et al (1984) Inter-observer variation between pathologists in the classification of cutaneous malignant melanoma in western Australia. Histopathology 8(5):717–729

    Article  CAS  Google Scholar 

  27. Colloby PS, West KP, Fletcher A (1991) Observer variation in the measurement of Breslow depth and Clark’s level in thin cutaneous malignant melanoma. J Pathol 163(3):245–250

    Article  CAS  Google Scholar 

  28. Yélamos O, Braun RP, Liopyris K, Wolner ZJ, Kerl K, Gerami P et al (2019) Usefulness of dermoscopy to improve the clinical and histopathologic diagnosis of skin cancers. J Am Acad Dermatol 80(2):365–377

    Article  Google Scholar 

  29. Carli P, De Giorgi V, Naldi L, Dosi G (1998) Reliability and inter-observer agreement of dermoscopic diagnosis of melanoma and melanocytic naevi. Eur J Cancer Prev 7(5):397–402

    Article  CAS  Google Scholar 

  30. Soyer HP, Massone C, Ferrara G, Argenziano G (2005) Limitations of histopathologic analysis in the recognition of melanoma: a plea for a combined diagnostic approach of histopathologic and dermoscopic evaluation. Arch Dermatol 141(2):209–211

    Article  Google Scholar 

  31. Longo C, Piana S, Lallas A, Moscarella E, Lombardi M, Raucci M et al (2015) Routine clinical-pathologic correlation of pigmented skin tumors can influence patient management. PLoS ONE 10(9):e0136031

    Article  Google Scholar 

  32. Bauer J, Metzler G, Rassner G, Garbe C, Blum A (2001) Dermatoscopy turns histopathologist’s attention to the suspicious area in melanocytic lesions. Arch Dermatol 137(10):1338–1340

    Article  CAS  Google Scholar 

  33. McGinnis KS, Lessin SR, Elder DE, Guerry D IV, Schuchter L, Ming M et al (2002) Pathology review of cases presenting to a multidisciplinary pigmented lesion clinic. Arch Dermatol 138(5):617–621

    Article  Google Scholar 

  34. Urso C (2000) Atypical histologic features in melanocytic nevi. Am J Dermatopathol 22(5):391–396

    Article  CAS  Google Scholar 

  35. Okun MR (1997) Silhouette symmetry: an unsupportable histologic criterion for distinguishing Spitz nevi and compound nevi from malignant melanoma. Arch Pathol Lab Med 121(1):48–53

    CAS  PubMed  Google Scholar 

  36. Okun MR (1998) Histological demarcation of lateral borders: an unsupportable criterion for distinguishing malignant melanoma from Spitz naevus and compound naevus. Histopathology 33(2):158–162

    Article  CAS  Google Scholar 

  37. Rosendahl C, Tschandl P, Cameron A, Kittler H (2011) Diagnostic accuracy of dermatoscopy for melanocytic and nonmelanocytic pigmented lesions. J Am Acad Dermatol 64(6):1068–1073

    Article  Google Scholar 

  38. Kittler H, Pehamberger H, Wolff K, Binder M (2002) Diagnostic accuracy of dermoscopy. Lancet Oncol 3(3):159–165

    Article  CAS  Google Scholar 

  39. Bafounta ML, Beauchet A, Aegerter P, Saiag P (2001) Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 137(10):1343–1350

    Article  CAS  Google Scholar 

  40. Pehamberger H, Binder M, Steiner A, Wolff K (1993) In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma. J Invest Dermatol 100(3):356S–362S

    Article  CAS  Google Scholar 

  41. Yélamos O, Braun RP, Liopyris K, Wolner ZJ, Kerl K, Gerami P et al (2019) Dermoscopy and dermatopathology correlates of cutaneous neoplasms. J Am Acad Dermatol 80(2):341–363

    Article  Google Scholar 

Download references

Funding

There are no funding sources to disclose.

Author information

Author notes

  1. Katherine Shi and Elsy Compres contributed equally to this article.

Authors and Affiliations

  1. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Katherine Shi, Elsy Compres, Lauren S. Mohan, Bin Zhang, Elnaz Panah, Victor L. Quan, Erin M. Garfield, Ayesha U. Khan, Daniel Kim, Pedram Yazdan, June K. Robinson & Pedram Gerami

  2. Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA

    Kara E. Walton

  3. Department of Dermatopathology, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA

    Pedram Gerami

Authors
  1. Katherine Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elsy Compres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kara E. Walton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lauren S. Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elnaz Panah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victor L. Quan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Erin M. Garfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ayesha U. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Daniel Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Pedram Yazdan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. June K. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pedram Gerami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pedram Gerami.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Reviewed and approved by Northwestern IRB, STU24696.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, K., Compres, E., Walton, K.E. et al. Incorporation of dermoscopy improves inter-observer agreement among dermatopathologists in histologic assessment of melanocytic neoplasms. Arch Dermatol Res 313, 101–108 (2021). https://doi.org/10.1007/s00403-020-02079-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-020-02079-w

Keywords

Search

Navigation