Agreement on the clinical diagnosis and management of cutaneous squamous neoplasms Journal Article

Authors: Terushkin, V.; Braga, J. C.; Dusza, S. W.; Scope, A.; Busam, K.; Marghoob, A. A.; Gill, M.; Halpern, A. C.
Article Title: Agreement on the clinical diagnosis and management of cutaneous squamous neoplasms
Abstract: BACKGROUND Diagnostic accuracy and preferred therapeutic strategies for actinic keratoses (AKs) and squamous cell carcinoma (SCC) have significant public health implications. OBJECTIVE To evaluate clinical-pathologic agreement on the diagnosis of AKs and early SCCs and to characterize the effect of diagnosis on therapeutic decisions. METHODS & MATERIALS Nine dermatologists and two dermatopathologists reviewed an image-based dataset of AKs and early SCCs. Clinical-pathologic agreement, inter- and intraobserver reliability for clinical diagnosis, and frequencies of therapies according to pathologic diagnosis were assessed. RESULTS Clinical-pathologic (κ=0.10) agreement was poor, whereas interobserver (κ=0.24) and intraobserver (κ=0.28) agreements were fair. Participants were more likely to treat AKs with cryotherapy (64.2%) and to manage SCCs with surgery (72.8%). Therapeutic choice rarely changed after participants were shown histological photomicrographs. Participating clinicians treated most lesions histologically diagnosed as SCC in situ arising within AK using surgery, whereas pathologists selected cryotherapy or curettage and electrodesiccation for these lesions. CONCLUSION We found poor clinical-pathologic agreement and reproducibility for clinically distinguishing between AK and early SCC even between skin cancer specialists from a single academic group practice. Nomenclature used in the pathologic diagnosis of AK and SCC affects clinicians' therapeutic decisions. The authors have indicated no significant interest with commercial supporters. © 2010 by the American Society for Dermatologic Surgery, Inc.
Keywords: clinical article; cancer surgery; squamous cell carcinoma; carcinoma, squamous cell; fluorouracil; united states; cancer diagnosis; diagnostic accuracy; medical decision making; reproducibility of results; actinic keratosis; skin biopsy; skin neoplasms; diagnosis, differential; algorithms; biopsy; histology; skin carcinoma; carcinoma in situ; keratosis, actinic; medical specialist; terminology as topic; photochemotherapy; mohs surgery; pathologist; dermatology; cryosurgery; skin surgery; curettage; cryotherapy; precancerous conditions; dermatologist; electrodesiccation; aminoquinolines
Journal Title: Dermatologic Surgery
Volume: 36
Issue: 10
ISSN: 1076-0512
Publisher: Lippincott Williams & Wilkins  
Date Published: 2010-10-01
Start Page: 1514
End Page: 1520
Language: English
DOI: 10.1111/j.1524-4725.2010.01675.x
PUBMED: 20698872
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: DESUF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Allan C Halpern
    383 Halpern
  2. Juliana Casagrande Tavoloni Braga
    5 Braga
  3. Stephen Dusza
    251 Dusza
  4. Alon Scope
    123 Scope
  5. Ashfaq A Marghoob
    503 Marghoob
  6. Klaus J Busam
    657 Busam