Abstract
63655 Melanoma diagnostic revision following pathologic review at an Iowa referral academic medical center
Journal of the American Academy of Dermatology, Vol.93(3 Suppl), pp.AB64-AB64
09/2025
DOI: 10.1016/j.jaad.2025.05.258
Abstract
Introduction: In Iowa, a highly rural state, many melanoma diagnoses are referred to the University of Iowa Health Care (UIHC) where repeat pathology interpretation is performed per protocol. The frequency and nature of discordance in this re-review and its impact on patient care has yet to be formally assessed.
Materials and Methods: This retrospective cohort study identified 243 cases of histopathologic review at UIHC between 2016-2021, excluding melanoma-in-situ and choroidal melanoma diagnoses. Frequency of revision was examined for major criteria including Breslow thickness and ulceration, and minor criteria including mitotic rate, histological subtype, Clark level, lymphovascular and/or neural invasion, tumor infiltrating lymphocytes, and microsatellitosis. McNemar tests were used to assess differences in histopathologic criteria. Differences in discordance rates were assessed using chi-square or Fisher’s exact tests.
Results: 11.5% (n=26/226) of cases demonstrated discordance in T-staging, which was informed by Breslow thickness (61.1%, n=11/18) and ulceration status (22.2%, n=4/18). Breslow thickness demonstrated discordance of 23.1% (n=54/234). Discordance of major criteria was 22.1% (n=27/122) while discordance in at least one minor element was 65.6% (n=80/122), including 38.2% (n=86/225) for mitotic rate. Margin status was discordant in 6.3% (n=15/138) of cases. Specifically, referring centers were more likely to identify transected margins (30.5%) compared to UIHC (23.5%) (p<0.01). Biopsy type had a statistically significant association with discordance in identifying transected margins: shave (17.7%), punch (12.9%), and excision (0%) (p<0.01).
Conclusion: Significant discordant elements exist in re-readings of melanoma cases in Iowa, often influencing staging and therefore treatment decisions, necessitating further study.
Details
- Title: Subtitle
- 63655 Melanoma diagnostic revision following pathologic review at an Iowa referral academic medical center
- Creators
- Mary Crompton - Carver College of Medicine University of IowaSydney Rand - University of IowaJacqueline Smart - Broadlawns Medical CenterAilynna Chen - University of IowaBradley Loeffler - University of IowaMohammed Milhem - University of IowaVincent Liu - University of IowaJennifer Powers - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Journal of the American Academy of Dermatology, Vol.93(3 Suppl), pp.AB64-AB64
- DOI
- 10.1016/j.jaad.2025.05.258
- ISSN
- 0190-9622
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 09/2025
- Academic Unit
- Dermatology; Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Internal Medicine
- Record Identifier
- 9984848118302771
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