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

Berta M. Geller, Paul D. Frederick, Stevan R. Knezevich, Jason P. Lott, Heidi Nelson, Linda J. Titus, Patricia (Patty) Carney, Anna N.A. Tosteson, Tracy L. Onega, Raymond L. Barnhill, Martin A. Weinstock, David E. Elder, Michael W. Piepkorn, Joann G. Elmore

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalDermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
Volume44
Issue number2
DOIs
StatePublished - Feb 1 2018

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Referral and Consultation
Skin
Melanoma
Pathologists
Pathology
Quality of Health Care
Malpractice
Neoplasms
Research

ASJC Scopus subject areas

  • Surgery
  • Dermatology

Cite this

Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions : Policies, Practices, and Perceptions. / Geller, Berta M.; Frederick, Paul D.; Knezevich, Stevan R.; Lott, Jason P.; Nelson, Heidi; Titus, Linda J.; Carney, Patricia (Patty); Tosteson, Anna N.A.; Onega, Tracy L.; Barnhill, Raymond L.; Weinstock, Martin A.; Elder, David E.; Piepkorn, Michael W.; Elmore, Joann G.

In: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], Vol. 44, No. 2, 01.02.2018, p. 177-185.

Research output: Contribution to journalArticle

Geller, BM, Frederick, PD, Knezevich, SR, Lott, JP, Nelson, H, Titus, LJ, Carney, PP, Tosteson, ANA, Onega, TL, Barnhill, RL, Weinstock, MA, Elder, DE, Piepkorn, MW & Elmore, JG 2018, 'Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions: Policies, Practices, and Perceptions', Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], vol. 44, no. 2, pp. 177-185. https://doi.org/10.1097/DSS.0000000000001256
Geller, Berta M. ; Frederick, Paul D. ; Knezevich, Stevan R. ; Lott, Jason P. ; Nelson, Heidi ; Titus, Linda J. ; Carney, Patricia (Patty) ; Tosteson, Anna N.A. ; Onega, Tracy L. ; Barnhill, Raymond L. ; Weinstock, Martin A. ; Elder, David E. ; Piepkorn, Michael W. ; Elmore, Joann G. / Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions : Policies, Practices, and Perceptions. In: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2018 ; Vol. 44, No. 2. pp. 177-185.
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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.",
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AU - Lott, Jason P.

AU - Nelson, Heidi

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AU - Carney, Patricia (Patty)

AU - Tosteson, Anna N.A.

AU - Onega, Tracy L.

AU - Barnhill, Raymond L.

AU - Weinstock, Martin A.

AU - Elder, David E.

AU - Piepkorn, Michael W.

AU - Elmore, Joann G.

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N2 - 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.

AB - 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.

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