Importance: There is poor accuracy and reproducibility for the histopathologic diagnosis of melanocytic skin lesions, and the provision of clinical information may improve this.
Objective: To examine the impact of clinical information on the histopathologic diagnosis of melanocytic skin lesions.
Evidence review: PubMed, Embase, and Cochrane Library were searched for new records published from January 2018 to January 2024. References included in the 2018 Cancer Council Australia evidence review were also screened, and forward and backward citation searches were conducted.
Findings: From 2224 records screened, 162 full-text studies were assessed, and 7 studies were included. Studies included pathologists from Austria, Germany, the US, Italy, the UK, and Australia. Patient populations had a mean age of 43 to 55 years and a proportion of female participants of 23% to 63%. The risk of bias assessment demonstrated that all studies had domains at unclear or high risk of bias. Clinical images increased diagnostic certainty (3 studies) and agreement between pathologists (2 studies) led to diagnostic upgrades in 7.6% to 16.7% of interpretations. Clinical diagnosis on the pathology requisition form reduced the odds of missing a melanoma with progression (1 study), while more clinical elements on the form correlated with higher re-excision rates (1 study). Among patients with distant metastases on long-term follow-up, a prior consensus diagnosis of melanoma was established on histopathology alone.
Conclusions and relevance: Providing clinical information to pathologists may improve diagnostic confidence and interobserver agreement and result in upgrading of the histopathologic diagnosis. While providing the clinical diagnosis may prevent missing a progressive melanoma, more research is needed to determine the appropriateness of histopathology upgrading when clinical images are provided and the impacts on patient outcomes.