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May 2002

The Fundamental Issue of Diagnosis

Author Affiliations

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Arch Dermatol. 2002;138(5):684-685. doi:10.1001/archderm.138.5.684

SOLVING CLINICAL problems begins with the determination of the nature of a diseased condition—a diagnosis. Once the diagnosis is established, a logical plan of action can be formulated and acted upon to resolve the abnormal condition. McGinnis et al,1 in this issue of the ARCHIVES, examined via a retrospective study, biopsy specimens from patients who were referred to their clinic for management of melanocytic tumors. They were interested in determining the concordance of diagnoses between the referring pathologist and the consultant pathologist at their institution, and whether a change in diagnosis would have an effect on the treatment. They found 11% of 5136 specimens had a significant change from the referral diagnosis with 1.2% being changed from malignant to benign and 1.1% from benign to malignant. The other 8% had either an upgrade or downgrade in severity sufficient to change management. Reexcision specimens were also reviewed; there was a change in margin status from involved to uninvolved or vice versa in 12% of 257 cases. A single expert pathologist in melanocytic tumors reviewed all of the pathological specimens at their institution. The background and qualifications of the referring pathologists were not provided. The authors concluded that a second review of pathological specimens of melanocytic tumors by a pathologist with experience in these tumors, within the context of referral to a specialty clinic, was warranted. Such a review resulted in a significant number of changed diagnoses that led to altered management.

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