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Grant Details

Grant Number: 5R01CA201376-05 Interpret this number
Primary Investigator: Elmore, Joann
Organization: University Of California Los Angeles
Project Title: Reducing Errors in the Diagnosis of Melanoma and Melanocytic Lesions
Fiscal Year: 2020


The proposed research will help to improve the accuracy of pathologists diagnosing melanoma and other melanocytic lesions. The incidence of melanoma is rising faster than any other cancer, and ~1 in 50 U.S. adults will be diagnosed with melanoma in 2015. Melanoma diagnosis is among the most challenging areas of histopathology because skin biopsies have a complex architectural structure that must be evaluated as part of the diagnosis; other types of biopsies require only cellular level assessment. Our previous work revealed substantial and frequent errors in diagnosis of melanoma: pathologists disagree in up to 60% of melanoma in situ and early stage invasive melanoma cases. Misdiagnosis can lead to substantial patient harm. The impact of these errors on public health may be growing given the increasing number of skin biopsies performed-an estimated 1 in 10 older U.S. adults currently undergo a skin biopsy procedure each year alone. The emerging technology of digitized slides (created by digitizing glass slides of skin biopsies) is expanding into pathology education and board certification testing. As digitized slides enable remote diagnosis from any computer, there is increasing interest in adopting digitized slides for primary diagnosis and/or second opinions. The FDA currently considers digitized slides a class III medical device, requiring additional data before approval for broad clinical use. We will compare the accuracy of 240 U.S. pathologists' diagnoses of digitized versus glass slides of melanocytic lesions in Phase I of our work (Aim 1). Validation of digitized slides is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. In Phase II, the same pathologists will re-diagnose the same cases (after a wash-out period), although they will not know they are the same cases. For some cases in Phase II, pathologists will be provided with a different pathologist's diagnosis from Phase I. Using data from both Phases, Aim 2 will then quantify bias associated with providing a consulting pathologist with a prior diagnosis. The digital medium also offers novel opportunities to study the causes of pathologists' errors. Aim 3 will evaluate initial visual search behaviors and whether Gestalt-like perception is associated with diagnostic accuracy when diagnosing digitized slides via novel eye-tracking technology. Our work will culminate in evaluating strategies based on the results of Aims 1-3 to reduce diagnostic errors by quantifying the potential impact of obtaining second opinions (Aim 4). No substantial attempts have been made to understand errors in the diagnosis of melanoma or to evaluate possible solutions. Our studies will identify underlying causes of diagnostic errors and guide design of future education and quality improvement efforts. These data are requisite for designing and implementing strategies to reduce the burden of diagnostic errors on patients and health care systems, to safely integrate digitized slides into clinical workflow, and to improve pathology practice.


Dermatopathologist Perceptions of Overdiagnosis of Melanocytic Skin Lesions and Association With Diagnostic Behaviors.
Authors: Kerr K.F. , Eguchi M.M. , Piepkorn M.W. , Radick A.C. , Reisch L.M. , Shucard H.L. , Knezevich S.R. , Barnhill R.L. , Elder D.E. , Elmore J.G. .
Source: JAMA dermatology, 2022-06-01; 158(6), p. 675-679.
PMID: 35442415
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Histopathological diagnosis of cutaneous melanocytic lesions: blinded and nonblinded second opinions offer similar improvement in diagnostic accuracy.
Authors: Kerr K.F. , Longton G.M. , Reisch L.M. , Radick A.C. , Eguchi M.M. , Shucard H.L. , Pepe M.S. , Piepkorn M.W. , Elder D.E. , Barnhill R.L. , et al. .
Source: Clinical and experimental dermatology, 2022-04-15; , .
EPub date: 2022-04-15.
PMID: 35426450
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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, 2022 Feb; 49(2), p. 153-162.
EPub date: 2021-09-21.
PMID: 34487353
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Association of Second-Opinion Strategies in the Histopathologic Diagnosis of Cutaneous Melanocytic Lesions With Diagnostic Accuracy and Population-Level Costs.
Authors: Tosteson A.N.A. , Tapp S. , Titus L.J. , Nelson H.D. , Longton G.M. , Bronson M. , Pepe M. , Carney P.A. , Onega T. , Piepkorn M.W. , et al. .
Source: JAMA dermatology, 2021-09-01; 157(9), p. 1102-1106.
PMID: 34076664
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Histopathologic synoptic reporting of invasive melanoma: How reliable are the data?
Authors: Taylor L.A. , Eguchi M.M. , Reisch L.M. , Radick A.C. , Shucard H. , Kerr K.F. , Piepkorn M.W. , Knezevich S.R. , Elder D.E. , Barnhill R.L. , et al. .
Source: Cancer, 2021-09-01; 127(17), p. 3125-3136.
EPub date: 2021-05-04.
PMID: 33945628
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Terminology for melanocytic skin lesions and the MPATH-Dx classification schema: A survey of dermatopathologists.
Authors: Radick A.C. , Reisch L.M. , Shucard H.L. , Piepkorn M.W. , Kerr K.F. , Elder D.E. , Barnhill R.L. , Knezevich S.R. , Oster N. , Elmore J.G. .
Source: Journal of cutaneous pathology, 2021 Jun; 48(6), p. 733-738.
EPub date: 2020-11-06.
PMID: 32935869
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Melanoma in the Blink of an Eye: Pathologists' Rapid Detection, Classification, and Localization of Skin Abnormalities.
Authors: BrunyƩ T.T. , Drew T. , Saikia M.J. , Kerr K.F. , Eguchi M.M. , Lee A.C. , May C. , Elder D.E. , Elmore J.G. .
Source: Visual cognition, 2021; 29(6), p. 386-400.
EPub date: 2021-06-16.
PMID: 35197796
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Malpractice and Patient Safety Concerns.
Authors: Reisch L.M. , Flores M.J. , Radick A.C. , Shucard H.L. , Kerr K.F. , Piepkorn M.W. , Barnhill R.L. , Elder D.E. , Knezevich S.R. , Elmore J.G. .
Source: American journal of clinical pathology, 2020-10-13; 154(5), p. 700-707.
PMID: 32651589
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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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Pathways to breast cancer screening artificial intelligence algorithm validation.
Authors: Lee C.I. , Houssami N. , Elmore J.G. , Buist D.S.M. .
Source: Breast (Edinburgh, Scotland), 2020 Aug; 52, p. 146-149.
EPub date: 2019-09-09.
PMID: 31540699
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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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Dermatopathologists' Experience With and Perceptions of Patient Online Access to Pathologic Test Result Reports.
Authors: Shucard H. , Piepkorn M.W. , Reisch L.M. , Kerr K.F. , Radick A.C. , Wang P.C. , Knezevich S.R. , Barnhill R.L. , Elder D.E. , Elmore J.G. .
Source: JAMA dermatology, 2020-03-01; 156(3), p. 320-324.
PMID: 31995131
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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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A review of eye tracking for understanding and improving diagnostic interpretation.
Authors: BrunyƩ T.T. , Drew T. , Weaver D.L. , Elmore J.G. .
Source: Cognitive research: principles and implications, 2019-02-22; 4(1), p. 7.
EPub date: 2019-02-22.
PMID: 30796618
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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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