Affordable Access

Publisher Website

Dermatopathologist Perceptions of Overdiagnosis of Melanocytic Skin Lesions and Association With Diagnostic Behaviors.

  • Kerr, Kathleen F1
  • Eguchi, Megan M2
  • Piepkorn, Michael W3, 4
  • Radick, Andrea C1
  • Reisch, Lisa M1
  • Shucard, Hannah L1
  • Knezevich, Stevan R5
  • Barnhill, Raymond L6, 7, 8
  • Elder, David E9
  • Elmore, Joann G2
  • 1 Department of Biostatistics, University of Washington, Seattle.
  • 2 Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine.
  • 3 Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle.
  • 4 Dermatopathology Northwest, Bellevue, Washington.
  • 5 Pathology Associates, Clovis, California.
  • 6 Department of Translational Research, Institut Curie, Paris, France. , (France)
  • 7 Paris Sciences and Lettres Research University, Paris, France. , (France)
  • 8 University of Paris UFR of Medicine, Paris, France. , (France)
  • 9 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia.
Published Article
JAMA dermatology
Publication Date
Apr 20, 2022
DOI: 10.1001/jamadermatol.2022.0489
PMID: 35442415


Despite evidence of overdiagnosis of in situ and invasive melanoma, neither the perceptions of practicing dermatopathologists about overdiagnosis nor possible associations between perceptions of overdiagnosis and diagnostic practices have been studied. To examine practicing US dermatopathologists' perceptions of melanoma overdiagnosis as a public health issue, and to associate diagnostic behaviors of dermatopathologists with perceptions of melanoma overdiagnosis. This survey study included 115 board-certified and/or fellowship-trained dermatopathologists and their diagnostic interpretations on a set of 18 skin biopsy cases (5 slide sets comprising 90 melanocytic skin lesions). Participants interpreted cases remotely using their own microscopes. Survey invitations occurred during 2018 to 2019, with data collection completed 2021. Data analysis was performed from June to September 2021. Agreement vs disagreement that overdiagnosis is a public health issue for atypical nevi, melanoma in situ, and invasive melanoma. Associations between perceptions regarding overdiagnosis and interpretive behavior on study cases. Of 115 dermatopathologists, 68% (95% CI, 59%-76%) agreed that overdiagnosis is a public health issue for atypical nevi; 47% (95% CI, 38%-56%) for melanoma in situ; and 35% (95% CI, 26%-43%) for invasive melanoma. Dermatopathologists with more years in practice were significantly less likely to perceive that atypical nevi are overdiagnosed, eg, 46% of dermatopathologists with 20 or more years of experience agreed that atypical nevi are overdiagnosed compared with 93% of dermatopathologists with 1 to 4 years of experience. Compared with other dermatopathologists, those who agreed that all 3 conditions are overdiagnosed were slightly more likely to diagnose study cases as mild to moderately dysplastic nevi (odds ratio, 1.26; 95% CI, 0.97-1.64; P = .08), but the difference was not statistically significant. Dermatopathologists who agreed that invasive melanoma is overdiagnosed did not significantly differ in diagnosing invasive melanoma for study cases compared with those who disagreed (odds ratio, 1.10; 95% CI, 0.86-1.41; P = .44). In this survey study, about two-thirds of dermatopathologists thought that atypical nevi are overdiagnosed, half thought that melanoma in situ is overdiagnosed, and one-third thought that invasive melanoma is overdiagnosed. No statistically significant associations were found between perceptions about overdiagnosis and interpretive behavior when diagnosing skin biopsy cases.

Report this publication


Seen <100 times