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Grant Details

Grant Number: 5R01CA151306-05 Interpret this number
Primary Investigator: Elmore, Joann
Organization: University Of Washington
Project Title: Accuracy in the Diagnosis of Melanoma & the Impact of Double Reading
Fiscal Year: 2015


A pathologist┬┐s assessment is the gold standard for deciding whether cancer is present or absent. However, community pathologists incorrectly diagnose melanoma in up to 17% of cases, while missing it altogether in 2%-13%. We will evaluate the extent of these diagnostic errors, their sources, and their impact on the U.S. population. Techniques that may reduce errors, such as double reading and continuing education, will also be evaluated. To achieve our goals, an expert panel of pathologists will establish a diagnosis for cases in 5 test sets using a Delphi approach. More than 100 U.S. pathologists will independently review two test sets during 2 phases, separated by 6 months. Our specific aims are: 1. To quantify the extent and evaluate possible sources of pathologists┬┐ errors in interpreting biopsy specimens of pigmented lesions. 2. To assess whether the addition of independent double reading by two or more pathologists on all or a subset of cases can improve interpretive accuracy. 3. To develop and evaluate an individualized Web-based educational intervention to reduce errors. 4. To quantify the implications of false negative and false positive interpretations and the impact of strategies to reduce errors on short-term patient care and associated resource utilization within the U.S. population. In summary, we will evaluate the accuracy of pathologists┬┐ interpretation of melanocytic lesions, emphasizing the classification of dysplastic nevi and early stage melanoma, where previous studies reveal a concerning degree of diagnostic error. This large multi-center study of community pathologists addresses a topic of growing clinical importance. Our research team includes international experts in melanoma pathology, statistical measurement of test accuracy, and studies of diagnostic accuracy in clinical medicine. The proposed work is innovative in that we will go beyond simply quantifying the existence of errors. We will study patient and pathologist characteristics associated with inaccurate diagnoses in order to identify possible reasons for diagnostic errors (e.g., inadequate detection vs. inadequate classification). We will then evaluate methods for improving health care delivery by using double reading and also an educational program that will be tested in a randomized intervention study. Finally, we will use a model-based analysis to make projections from our data to the clinical implications of inaccurate diagnoses at the U.S. population level.


Characterization of multiple diagnostic terms in melanocytic skin lesion pathology reports.
Authors: Chang O.H. , Elder D.E. , Barnhill R.L. , Piepkorn M.W. , Eguchi M.M. , Knezevich S.R. , Lee A.C. , Moreno R.J. , Kerr K.F. , Elmore J.G. .
Source: Journal of cutaneous pathology, 2021-09-06; , .
EPub date: 2021-09-06.
PMID: 34487353
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Factors associated with use of immunohistochemical markers in the histopathological diagnosis of cutaneous melanocytic lesions.
Authors: May C.J. , Piepkorn M.W. , Knezevich S.R. , Elder D.E. , Barnhill R.L. , Lee A.C. , Flores M.J. , Kerr K.F. , Reisch L.M. , Elmore J.G. .
Source: Journal of cutaneous pathology, 2020 Oct; 47(10), p. 896-902.
EPub date: 2020-07-17.
PMID: 32383301
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Pathologists' agreement on treatment suggestions for melanocytic skin lesions.
Authors: Jafry M.A. , Peacock S. , Radick A.C. , Shucard H.L. , Reisch L.M. , Piepkorn M.W. , Knezevich S.R. , Weinstock M.A. , Barnhill R.L. , Elder D.E. , et al. .
Source: Journal of the American Academy of Dermatology, 2020 Jun; 82(6), p. 1435-1444.
EPub date: 2019-12-17.
PMID: 31862403
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Assessment of Second-Opinion Strategies for Diagnoses of Cutaneous Melanocytic Lesions.
Authors: Piepkorn M.W. , Longton G.M. , Reisch L.M. , Elder D.E. , Pepe M.S. , Kerr K.F. , Tosteson A.N.A. , Nelson H.D. , Knezevich S. , Radick A. , et al. .
Source: JAMA network open, 2019-10-02; 2(10), p. e1912597.
EPub date: 2019-10-02.
PMID: 31603483
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Accuracy of Digital Pathologic Analysis vs Traditional Microscopy in the Interpretation of Melanocytic Lesions.
Authors: Onega T. , Barnhill R.L. , Piepkorn M.W. , Longton G.M. , Elder D.E. , Weinstock M.A. , Knezevich S.R. , Reisch L.M. , Carney P.A. , Nelson H.D. , et al. .
Source: JAMA dermatology, 2018-10-01; 154(10), p. 1159-1166.
PMID: 30140929
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Malpractice Concerns, Defensive Medicine, and the Histopathology Diagnosis of Melanocytic Skin Lesions.
Authors: Titus L.J. , Reisch L.M. , Tosteson A.N.A. , Nelson H.D. , Frederick P.D. , Carney P.A. , Barnhill R.L. , Elder D.E. , Weinstock M.A. , Piepkorn M.W. , et al. .
Source: American journal of clinical pathology, 2018-08-30; 150(4), p. 338-345.
PMID: 30007278
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Influence of variability in assessment of Breslow thickness, mitotic rate and ulceration among US pathologists interpreting invasive melanoma, for the purpose of AJCC staging.
Authors: Taylor L. , Hood K. , Reisch L. , Elmore J. , Piepkorn M. , Barnhill R. , Knezevich S. , Radick A. , Elder D. .
Source: Journal of cutaneous pathology, 2018 Aug; 45(8), p. 588-596.
EPub date: 2018-05-29.
PMID: 29717800
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Complexities of perceived and actual performance in pathology interpretation: A comparison of cutaneous melanocytic skin and breast interpretations.
Authors: Carney P.A. , Frederick P.D. , Reisch L.M. , Titus L. , Knezevich S.R. , Weinstock M.A. , Piepkorn M.W. , Barnhill R.L. , Elder D.E. , Weaver D.L. , et al. .
Source: Journal of cutaneous pathology, 2018 Jul; 45(7), p. 478-490.
EPub date: 2018-04-26.
PMID: 29603324
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Pathologist characteristics associated with accuracy and reproducibility of melanocytic skin lesion interpretation.
Authors: Elder D.E. , Piepkorn M.W. , Barnhill R.L. , Longton G.M. , Nelson H.D. , Knezevich S.R. , Pepe M.S. , Carney P.A. , Titus L.J. , Onega T. , et al. .
Source: Journal of the American Academy of Dermatology, 2018 Jul; 79(1), p. 52-59.e5.
EPub date: 2018-03-07.
PMID: 29524584
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Characteristics and diagnostic performance of pathologists who enjoy interpreting melanocytic lesions.
Authors: Radick A.C. , Phipps A.I. , Piepkorn M.W. , Nelson H.D. , Barnhill R.L. , Elder D.E. , Reisch L.M. , Frederick P.D. , Elmore J.G. .
Source: Dermatology online journal, 2018-06-15; 24(6), .
EPub date: 2018-06-15.
PMID: 30142708
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Concordance and Reproducibility of Melanoma Staging According to the 7th vs 8th Edition of the AJCC Cancer Staging Manual.
Authors: Elmore J.G. , Elder D.E. , Barnhill R.L. , Knezevich S.R. , Longton G.M. , Titus L.J. , Weinstock M.A. , Pepe M.S. , Nelson H.D. , Reisch L.M. , et al. .
Source: JAMA network open, 2018 05; 1(1), .
PMID: 30556054
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Pathologists' Use of Second Opinions in Interpretation of Melanocytic Cutaneous Lesions: Policies, Practices, and Perceptions.
Authors: Geller B.M. , Frederick P.D. , Knezevich S.R. , Lott J.P. , Nelson H.D. , Titus L.J. , Carney P.A. , Tosteson A.N.A. , Onega T.L. , Barnhill R.L. , et al. .
Source: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2018 Feb; 44(2), p. 177-185.
PMID: 28858936
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Skin biopsy utilization and melanoma incidence among Medicare beneficiaries.
Authors: Weinstock M.A. , Lott J.P. , Wang Q. , Titus L.J. , Onega T. , Nelson H.D. , Pearson L. , Piepkorn M. , Barnhill R.L. , Elmore J.G. , et al. .
Source: The British journal of dermatology, 2017 Apr; 176(4), p. 949-954.
EPub date: 2017-03-01.
PMID: 27639256
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The influence of tumor regression, solar elastosis, and patient age on pathologists' interpretation of melanocytic skin lesions.
Authors: Titus L. , Barnhill R.L. , Lott J.P. , Piepkorn M.W. , Elder D.E. , Frederick P.D. , Nelson H.D. , Carney P.A. , Knezevich S.R. , Weinstock M.A. , et al. .
Source: Laboratory investigation; a journal of technical methods and pathology, 2017 02; 97(2), p. 187-193.
EPub date: 2016-11-28.
PMID: 27892931
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The utilization of spitz-related nomenclature in the histological interpretation of cutaneous melanocytic lesions by practicing pathologists: results from the M-Path study.
Authors: Zhao G. , Lee K.C. , Peacock S. , Reisch L.M. , Knezevich S.R. , Elder D.E. , Piepkorn M.W. , Elmore J.G. , Barnhill R.L. .
Source: Journal of cutaneous pathology, 2017 Jan; 44(1), p. 5-14.
EPub date: 2016-10-28.
PMID: 27686456
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Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists.
Authors: Lee K.C. , Peacock S. , Weinstock M.A. , Zhao G.A. , Knezevich S.R. , Elder D.E. , Barnhill R.L. , Piepkorn M.W. , Reisch L.M. , Carney P.A. , et al. .
Source: Journal of the American Academy of Dermatology, 2017 Jan; 76(1), p. 121-128.
EPub date: 2016-09-28.
PMID: 27692732
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Achieving consensus for the histopathologic diagnosis of melanocytic lesions: use of the modified Delphi method.
Authors: Carney P.A. , Reisch L.M. , Piepkorn M.W. , Barnhill R.L. , Elder D.E. , Knezevich S. , Geller B.M. , Longton G. , Elmore J.G. .
Source: Journal of cutaneous pathology, 2016 Oct; 43(10), p. 830-7.
EPub date: 2016-07-01.
PMID: 27247109
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Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group.
Authors: Lott J.P. , Elmore J.G. , Zhao G.A. , Knezevich S.R. , Frederick P.D. , Reisch L.M. , Chu E.Y. , Cook M.G. , Duncan L.M. , Elenitsas R. , et al. .
Source: Journal of the American Academy of Dermatology, 2016 Aug; 75(2), p. 356-63.
EPub date: 2016-05-14.
PMID: 27189823
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The self-reported use of immunostains and cytogenetic testing in the diagnosis of melanoma by practicing U.S. pathologists of 10 selected states.
Authors: Zhao G. , Lee K.C. , Kwon G. , Frederick P.D. , Onega T.L. , Piepkorn M.W. , Knezevich S. , Barnhill R.L. , Elder D.E. , Elmore J.G. .
Source: Journal of cutaneous pathology, 2016 Jun; 43(6), p. 492-7.
EPub date: 2016-04-07.
PMID: 26968847
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Use of Digital Whole Slide Imaging in Dermatopathology.
Authors: Onega T. , Reisch L.M. , Frederick P.D. , Geller B.M. , Nelson H.D. , Lott J.P. , Radick A.C. , Elder D.E. , Barnhill R.L. , Piepkorn M.W. , et al. .
Source: Journal of digital imaging, 2016 Apr; 29(2), p. 243-53.
PMID: 26546178
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How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions.
Authors: Carney P.A. , Frederick P.D. , Reisch L.M. , Knezevich S. , Piepkorn M.W. , Barnhill R.L. , Elder D.E. , Geller B.M. , Titus L. , Weinstock M.A. , et al. .
Source: Journal of the American Academy of Dermatology, 2016 Feb; 74(2), p. 317-24; quiz 324.e1-8.
EPub date: 2015-11-11.
PMID: 26559597
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Variability in mitotic figures in serial sections of thin melanomas.
Authors: Knezevich S.R. , Barnhill R.L. , Elder D.E. , Piepkorn M.W. , Reisch L.M. , Pocobelli G. , Carney P.A. , Elmore J.G. .
Source: Journal of the American Academy of Dermatology, 2014 Dec; 71(6), p. 1204-11.
EPub date: 2014-09-16.
PMID: 25239732
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The MPATH-Dx reporting schema for melanocytic proliferations and melanoma.
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Source: Journal of the American Academy of Dermatology, 2014 Jan; 70(1), p. 131-41.
EPub date: 2013-10-28.
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Source: JAMA dermatology, 2013 Nov; 149(11), p. 1295-9.
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