The dark side of pathology.

June 30, 2017. Evidence for the utility of total body skin exams (TBSE) as a screening tool for melanoma is murky at best. Yet ask any dermatologist, and you find will a passionate advocate of the method. In their defense, maybe we should look beyond screener error when trying to explain the notoriously wide ranges of accuracy. In this week’s BMJ pub, 187 pathologists from 10 states were each asked to review matching sets of pigmented lesion biopsies at two separate time points. Both intra- and interobserver concordance rates were low for anything other than the far ends of the spectrum (read: the vast majority of melanocytic lesions)which the authors translate to nationwide rates of 8% over-interpretation and 9% under-interpretation of all pigmented lesion biopsies. Before we pick a side on the TBSE debate, can we get a second opinion?

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