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September 9, 1998

Clinical Diagnosis of Moles vs Melanoma—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(10):881-882. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-10-jac80015

In Reply.—Histopathologic examination of a biopsy specimen is currently the best method available for categorizing the presence or absence of melanoma. Drs Swerlick and Solomon correctly point out that, like most gold standards, it is imperfect. The issue they raise is whether there is enough uncertainty regarding its usefulness to make histopathologic examination an acceptable reference standard. The study they reference1 regarding the reliability of pathologists' diagnoses for melanoma indicates a moderate level of agreement and is a low estimate compared with other studies24 that have shown a level of interobserver agreement that is considered substantial.5 One study3 noted a high level of agreement only after implementing standardized diagnostic criteria, however. Nevertheless, Swerlick and Solomon are correct in pointing out that diagnostic reliability among pathologists is not perfect. For now, however, pathologic examination is relied on to classify the disease state and functions as an accepted gold standard, although an imperfect one. Perhaps in the future, tumor markers or some other means of diagnosis may surpass histopathologic review as a better diagnostic test.

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