The influence of tumor regression, solar elastosis, and patient age on pathologists’ interpretation of melanocytic skin lesions

It is not known whether patient age or tumor characteristics such as tumor regression or solar elastosis influence pathologists’ interpretation of melanocytic skin lesions. We undertook a study to determine the influence of these factors, and to explore pathologist characteristics associated with the direction of diagnosis. To meet our objective, we designed a cross-sectional survey study of pathologists’ clinical practices and perceptions. Pathologists were recruited from diverse practices in ten states in the U.S. We enrolled 207 pathologist participants whose practice included the interpretation of melanocytic skin lesions. Our findings indicated that the majority of pathologists (54.6%) were influenced toward a less severe diagnosis when patients were <30 years of age. Most pathologists were influenced toward a more severe diagnosis when patients were >70 years of age, or by the presence of tumor regression or solar elastosis (58.6%, 71.0%, 57.0%, respectively). Generally, pathologists with dermatopathology board certification and/or a high caseload of melanocytic skin lesions were more likely to be influenced, while those with more years’ experience interpreting MSL were less likely to be influenced. Our findings indicate that the interpretation of melanocytic skin lesions is influenced by patient age, tumor regression, and solar elastosis; such influence is associated with dermatopathology training and higher caseload, consistent with expertise and an appreciation of lesion complexity.