Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study

Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized...

Celý popis

Uložené v:

Podrobná bibliografia
Vydané v:	BMJ (Online) Ročník 357; s. j2813
Hlavní autori:	Elmore, Joann G, Barnhill, Raymond L, Elder, David E, Longton, Gary M, Pepe, Margaret S, Reisch, Lisa M, Carney, Patricia A, Titus, Linda J, Nelson, Heidi D, Onega, Tracy, Tosteson, Anna N A, Weinstock, Martin A, Knezevich, Stevan R, Piepkorn, Michael W
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England BMJ Publishing Group LTD 28.06.2017 BMJ Publishing Group Ltd
Predmet:	Accuracy Adult Biopsy Classification Clinical Competence - statistics & numerical data Diagnosis Diagnosis, Differential Diagnostic Errors Evolution & development Histology Humans Lymphatic system Medical diagnosis Melanoma Melanoma - diagnosis Melanoma, Cutaneous Malignant Middle Aged Nevus Nevus, Pigmented - diagnosis Observer Variation Pathology Pathology, Clinical - standards Physicians Reproducibility Reproducibility of Results Reviews Skin cancer Skin diseases Skin Neoplasms - diagnosis United States Visual perception United States > US
ISSN:	0959-8138, 1756-1833, 1756-1833
On-line prístup:	Získať plný text
Tagy:	Pridať tag Žiadne tagy, Buďte prvý, kto otaguje tento záznam!

Abstract	Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart.Main outcome measures Pathologists’ interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses.Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted.Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments.
AbstractList	Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions. Design Observer accuracy and reproducibility study. Setting 10 US states. Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart. Main outcome measures Pathologists’ interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses. Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted. Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments. Objective To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions. Design Observer accuracy and reproducibility study. Setting 10 US states. Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart. Main outcome measures Pathologists' interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses. Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted. Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists' visual assessments. To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions. Observer accuracy and reproducibility study. 10 US states. Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart. Pathologists' interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses. In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted. Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists' visual assessments. Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart.Main outcome measures Pathologists’ interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses.Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted.Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments. Objective To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart.Main outcome measures Pathologists' interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses.Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted.Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists' visual assessments.Objective To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility study.Setting 10 US states.Participants Skin biopsy cases (n=240), grouped into sets of 36 or 48. Pathologists from 10 US states were randomized to independently interpret the same set on two occasions (phases 1 and 2), at least eight months apart.Main outcome measures Pathologists' interpretations were condensed into five classes: I (eg, nevus or mild atypia); II (eg, moderate atypia); III (eg, severe atypia or melanoma in situ); IV (eg, pathologic stage T1a (pT1a) early invasive melanoma); and V (eg, ≥pT1b invasive melanoma). Reproducibility was assessed by intraobserver and interobserver concordance rates, and accuracy by concordance with three reference diagnoses.Results In phase 1, 187 pathologists completed 8976 independent case interpretations resulting in an average of 10 (SD 4) different diagnostic terms applied to each case. Among pathologists interpreting the same cases in both phases, when pathologists diagnosed a case as class I or class V during phase 1, they gave the same diagnosis in phase 2 for the majority of cases (class I 76.7%; class V 82.6%). However, the intraobserver reproducibility was lower for cases interpreted as class II (35.2%), class III (59.5%), and class IV (63.2%). Average interobserver concordance rates were lower, but with similar trends. Accuracy using a consensus diagnosis of experienced pathologists as reference varied by class: I, 92% (95% confidence interval 90% to 94%); II, 25% (22% to 28%); III, 40% (37% to 44%); IV, 43% (39% to 46%); and V, 72% (69% to 75%). It is estimated that at a population level, 82.8% (81.0% to 84.5%) of melanocytic skin biopsy diagnoses would have their diagnosis verified if reviewed by a consensus reference panel of experienced pathologists, with 8.0% (6.2% to 9.9%) of cases overinterpreted by the initial pathologist and 9.2% (8.8% to 9.6%) underinterpreted.Conclusion Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate in this large study of pathologists in the USA. Efforts to improve clinical practice should include using a standardized classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists' visual assessments.
Author	Nelson, Heidi D Knezevich, Stevan R Onega, Tracy Weinstock, Martin A Piepkorn, Michael W Barnhill, Raymond L Tosteson, Anna N A Carney, Patricia A Elmore, Joann G Elder, David E Titus, Linda J Longton, Gary M Pepe, Margaret S Reisch, Lisa M
Author_xml	– sequence: 1 givenname: Joann G surname: Elmore fullname: Elmore, Joann G email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 2 givenname: Raymond L surname: Barnhill fullname: Barnhill, Raymond L email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 3 givenname: David E surname: Elder fullname: Elder, David E email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 4 givenname: Gary M surname: Longton fullname: Longton, Gary M email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 5 givenname: Margaret S surname: Pepe fullname: Pepe, Margaret S email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 6 givenname: Lisa M surname: Reisch fullname: Reisch, Lisa M email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 7 givenname: Patricia A surname: Carney fullname: Carney, Patricia A email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 8 givenname: Linda J surname: Titus fullname: Titus, Linda J email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 9 givenname: Heidi D surname: Nelson fullname: Nelson, Heidi D email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 10 givenname: Tracy surname: Onega fullname: Onega, Tracy email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 11 givenname: Anna N A surname: Tosteson fullname: Tosteson, Anna N A email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 12 givenname: Martin A surname: Weinstock fullname: Weinstock, Martin A email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 13 givenname: Stevan R surname: Knezevich fullname: Knezevich, Stevan R email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA – sequence: 14 givenname: Michael W surname: Piepkorn fullname: Piepkorn, Michael W email: jelmore@uw.edu organization: Dermatopathology Northwest, Bellevue, WA, USA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/28659278$$D View this record in MEDLINE/PubMed
BookMark	eNp1kc1u1DAUhS1URIfSBS-AItFFWaS149ixWSChip9KlWABa8t_mXqU2IPtjJSueI2-Hk-COzNUtIKV5Xu_e3TPPc_BgQ_eAvASwTOEMD1X4-ps1TCEn4AF6gitEcP4ACwgJ7wuZXYIjlNaQQgb3DFOyTNw2DBKeNOxBbj5KvN1GMLSpZx-_bytjJNLH5JLVegr5zcyuY2tRjtIH0ZZSW_2Hz1np6t1DIPrbZTZBZ_eVkElGzc2VlLrKUo9byeiLZyZtFNucHmuUp7M_AI87eWQ7PH-PQLfP374dvG5vvry6fLi_VWtWs5yTRCV1DS9odQqbgxFBmHdIGW6jrecFF8ESohbRJAmfct41xAFO6NkV-6h8BF4t9NdT2q0RlufoxzEOrpRxlkE6cTDjnfXYhk2grSMcISLwOleIIYfk01ZjC5pO5Qr2DAlgThqWdsRTgr6-hG6ClP0xd6WanELGS3Uq783ul_lTywFeLMDdAwpRdvfIwiKu9RFSV1sUy_s-SNWu7yNo5hxwz8nTnYTd6X_C_8GNJO_FA
CitedBy_id	crossref_primary_10_1001_jamadermatol_2018_4377 crossref_primary_10_1001_jamadermatol_2024_2817 crossref_primary_10_1111_jdv_20188 crossref_primary_10_3390_cancers11122041 crossref_primary_10_1016_j_jid_2018_10_041 crossref_primary_10_3390_cancers16020278 crossref_primary_10_1016_j_ebiom_2019_04_055 crossref_primary_10_1093_jnci_djae006 crossref_primary_10_1093_bjd_ljad137 crossref_primary_10_1016_j_jid_2022_03_028 crossref_primary_10_3389_fmed_2020_568946 crossref_primary_10_1056_NEJMra1814259 crossref_primary_10_1016_j_jid_2020_03_949 crossref_primary_10_1016_j_jaad_2020_03_122 crossref_primary_10_1093_jnci_djac195 crossref_primary_10_1111_pin_13292 crossref_primary_10_1371_journal_pone_0297146 crossref_primary_10_1111_1556_4029_13735 crossref_primary_10_1111_ajd_13705 crossref_primary_10_1016_j_jaad_2022_04_068 crossref_primary_10_3390_cancers15184463 crossref_primary_10_1111_cup_14788 crossref_primary_10_1001_jamadermatol_2021_1779 crossref_primary_10_1111_jdv_20055 crossref_primary_10_1097_CMR_0000000000000478 crossref_primary_10_1016_j_artmed_2020_101822 crossref_primary_10_1016_j_jaad_2022_11_019 crossref_primary_10_1038_s41598_023_46014_1 crossref_primary_10_1186_s12920_024_02028_w crossref_primary_10_1016_j_mpdhp_2019_12_005 crossref_primary_10_1117_1_JMI_10_2_025503 crossref_primary_10_1016_j_jid_2019_11_028 crossref_primary_10_1002_jvc2_70144 crossref_primary_10_3390_ijms24021079 crossref_primary_10_1111_jdv_15257 crossref_primary_10_1111_ajd_14008 crossref_primary_10_1111_cup_14312 crossref_primary_10_1001_jamadermatol_2024_2599 crossref_primary_10_1063_5_0190573 crossref_primary_10_1111_cup_14671 crossref_primary_10_1136_bmjopen_2022_069694 crossref_primary_10_1016_j_jid_2021_12_003 crossref_primary_10_1111_ced_15094 crossref_primary_10_1038_s41598_023_31526_7 crossref_primary_10_1093_bjd_ljae013 crossref_primary_10_1097_DSS_0000000000002932 crossref_primary_10_1001_jamadermatol_2023_0127 crossref_primary_10_5858_arpa_2017_0547_RA crossref_primary_10_3389_fonc_2023_1296826 crossref_primary_10_1038_s41379_018_0197_1 crossref_primary_10_3390_cancers16111989 crossref_primary_10_1016_j_adengl_2017_09_004 crossref_primary_10_1177_23814683211069988 crossref_primary_10_1111_ajd_13603 crossref_primary_10_1080_0284186X_2019_1616817 crossref_primary_10_1111_cup_14562 crossref_primary_10_1007_s12094_018_1900_x crossref_primary_10_1056_NEJMp1907407 crossref_primary_10_3390_dermatopathology10010014 crossref_primary_10_1016_j_clindermatol_2024_09_007 crossref_primary_10_1016_j_compmedimag_2020_101832 crossref_primary_10_1007_s00105_023_05182_x crossref_primary_10_1111_bjd_16932 crossref_primary_10_1038_s41598_020_59985_2 crossref_primary_10_1007_s15012_017_2512_9 crossref_primary_10_1001_jamadermatol_2019_4194 crossref_primary_10_1111_ajd_13609 crossref_primary_10_1111_jdv_18346 crossref_primary_10_1111_jdv_14782 crossref_primary_10_1056_NEJMsb2019760 crossref_primary_10_1093_ajcp_aqaa088 crossref_primary_10_1016_j_ad_2017_09_018 crossref_primary_10_25251_skin_4_2_5 crossref_primary_10_5858_arpa_2020_0620_OA crossref_primary_10_3389_fonc_2021_636681 crossref_primary_10_1007_s10278_022_00641_8 crossref_primary_10_1155_2023_1443308 crossref_primary_10_1016_j_humpath_2023_05_002 crossref_primary_10_1016_j_jdin_2022_06_017 crossref_primary_10_1016_j_ejca_2019_09_018 crossref_primary_10_3389_fmed_2023_1268479 crossref_primary_10_1111_jdv_20412 crossref_primary_10_1093_jnci_djac138 crossref_primary_10_1111_jdv_20655 crossref_primary_10_1053_j_semdp_2022_01_003 crossref_primary_10_1155_2021_6238317 crossref_primary_10_1097_PAS_0000000000001878 crossref_primary_10_1111_1346_8138_14737 crossref_primary_10_3390_ijms222111918 crossref_primary_10_1002_ski2_237 crossref_primary_10_1001_jamadermatol_2023_6417 crossref_primary_10_3389_fmed_2021_775587 crossref_primary_10_3390_dermatopathology12010003 crossref_primary_10_1007_s13671_019_00267_0 crossref_primary_10_3390_ijms21249583 crossref_primary_10_1111_ced_15219 crossref_primary_10_1001_jamadermatol_2018_3303 crossref_primary_10_1001_jamadermatol_2022_0489 crossref_primary_10_1016_j_jid_2019_07_688 crossref_primary_10_1111_cup_13147 crossref_primary_10_3390_diagnostics12071713 crossref_primary_10_3390_life13091803 crossref_primary_10_5858_arpa_2018_0038_RA crossref_primary_10_1111_cup_13265 crossref_primary_10_1038_s41698_025_00853_5 crossref_primary_10_1016_j_adengl_2018_08_007 crossref_primary_10_1093_bjd_ljae175 crossref_primary_10_3390_cancers13112838 crossref_primary_10_2217_mmt_2020_0008 crossref_primary_10_1016_j_jid_2023_02_035 crossref_primary_10_1136_jclinpath_2019_205767 crossref_primary_10_1038_s41379_020_0499_y crossref_primary_10_1177_12034754221108978 crossref_primary_10_1016_j_survophthal_2018_12_002 crossref_primary_10_1016_j_jacr_2024_12_011 crossref_primary_10_1038_s41379_020_0490_7 crossref_primary_10_1016_j_prp_2022_154014 crossref_primary_10_1097_DSS_0000000000003280 crossref_primary_10_1136_bmjopen_2024_089558 crossref_primary_10_1111_jdv_18436 crossref_primary_10_1016_j_mpdhp_2018_06_004 crossref_primary_10_1111_cup_14126 crossref_primary_10_5858_arpa_2021_0550_OA crossref_primary_10_1016_j_ejca_2019_04_021 crossref_primary_10_3389_fmed_2024_1388422 crossref_primary_10_1016_j_jaad_2020_12_022 crossref_primary_10_1016_j_ejca_2023_113395 crossref_primary_10_2217_bmm_2021_0289 crossref_primary_10_1016_j_ejca_2023_05_009 crossref_primary_10_1016_j_jaad_2019_12_077 crossref_primary_10_1136_bmjopen_2018_022457 crossref_primary_10_1016_j_jaad_2020_03_093 crossref_primary_10_1109_ACCESS_2021_3132958 crossref_primary_10_3390_diagnostics9030103 crossref_primary_10_1001_jamanetworkopen_2019_12597 crossref_primary_10_1111_jdv_20344 crossref_primary_10_1016_j_critrevonc_2024_104435 crossref_primary_10_1371_journal_pone_0274413 crossref_primary_10_1016_j_jaad_2018_08_055 crossref_primary_10_1080_07357907_2022_2134415 crossref_primary_10_1111_bjd_19015 crossref_primary_10_1016_j_ad_2018_08_017 crossref_primary_10_1111_bjd_18609 crossref_primary_10_1002_adfm_202010296 crossref_primary_10_5694_mja2_50759 crossref_primary_10_1001_jamadermatol_2024_4281 crossref_primary_10_3390_diagnostics12081972 crossref_primary_10_3390_bios15050297 crossref_primary_10_1111_cup_13736 crossref_primary_10_1007_s12634_017_5480_5 crossref_primary_10_1111_cup_13854 crossref_primary_10_3390_epigenomes7020009 crossref_primary_10_1016_j_pathol_2017_09_002 crossref_primary_10_1001_jamanetworkopen_2018_0083 crossref_primary_10_1242_jcs_262322 crossref_primary_10_1111_bjd_16557 crossref_primary_10_1002_cncr_33612 crossref_primary_10_1001_jamanetworkopen_2018_0086 crossref_primary_10_5694_mja2_50502 crossref_primary_10_3389_frai_2022_1005086 crossref_primary_10_1016_S2352_4642_19_30005_7 crossref_primary_10_1016_j_ad_2025_04_004 crossref_primary_10_1111_jep_13428 crossref_primary_10_1080_10408363_2022_2114418 crossref_primary_10_1007_s00428_021_03095_5 crossref_primary_10_1007_s40257_025_00943_x crossref_primary_10_3390_cancers15184631 crossref_primary_10_3390_cancers17071218 crossref_primary_10_1016_j_prp_2024_155177 crossref_primary_10_1111_ajd_14087 crossref_primary_10_1038_s41467_025_56160_x crossref_primary_10_3389_fmed_2021_642380 crossref_primary_10_3390_diagnostics13132294 crossref_primary_10_3390_dermatopathology9040043 crossref_primary_10_3390_bioengineering12091001 crossref_primary_10_1016_j_jid_2019_05_003 crossref_primary_10_1111_his_14570 crossref_primary_10_3390_cancers15051428 crossref_primary_10_1186_s12905_020_00902_0 crossref_primary_10_1111_cup_14717 crossref_primary_10_3389_fonc_2020_01559 crossref_primary_10_1016_j_pathol_2022_12_341 crossref_primary_10_1111_cup_13513 crossref_primary_10_25259_Cytojournal_272_2024 crossref_primary_10_3390_biom13091327 crossref_primary_10_1016_j_jaad_2021_06_010 crossref_primary_10_1111_cup_13873 crossref_primary_10_1111_cup_13994 crossref_primary_10_3390_diagnostics14141522 crossref_primary_10_1016_j_jid_2021_06_023 crossref_primary_10_1038_s44385_025_00013_1 crossref_primary_10_1111_cup_14165 crossref_primary_10_1111_his_15428 crossref_primary_10_1001_jamadermatol_2019_1514 crossref_primary_10_1001_jamadermatol_2023_5550 crossref_primary_10_1111_srt_13023 crossref_primary_10_7554_eLife_34364 crossref_primary_10_1001_jamadermatol_2023_4334 crossref_primary_10_1038_s41467_024_51012_6 crossref_primary_10_1093_ajcp_aqy057 crossref_primary_10_1016_j_pathol_2022_12_343 crossref_primary_10_1016_j_ejca_2019_05_023 crossref_primary_10_1016_j_pathol_2022_12_345 crossref_primary_10_1158_1078_0432_CCR_24_1902 crossref_primary_10_1038_s41416_018_0257_9 crossref_primary_10_1111_ijd_17827 crossref_primary_10_2217_pme_2023_0110 crossref_primary_10_1093_jnci_djaa008 crossref_primary_10_1016_j_prp_2025_155953 crossref_primary_10_1111_ajd_13697 crossref_primary_10_1111_jdv_20382 crossref_primary_10_3390_cancers13215336 crossref_primary_10_1016_j_ejca_2019_12_024 crossref_primary_10_1016_j_jid_2021_12_031 crossref_primary_10_3389_fmed_2021_635316 crossref_primary_10_2217_mmt_2023_0002 crossref_primary_10_1371_journal_pone_0298830 crossref_primary_10_3389_fonc_2025_1604442 crossref_primary_10_1097_DSS_0000000000002473 crossref_primary_10_1016_j_jaad_2020_11_047 crossref_primary_10_1016_j_jaad_2023_09_074 crossref_primary_10_1038_s41698_022_00252_0 crossref_primary_10_1007_s13555_020_00355_1 crossref_primary_10_1111_odi_15078 crossref_primary_10_1001_jamadermatol_2018_2388 crossref_primary_10_1089_thy_2021_0274 crossref_primary_10_1111_cup_14866 crossref_primary_10_1016_j_ad_2024_05_023 crossref_primary_10_1111_bjd_21010 crossref_primary_10_1111_cup_14742 crossref_primary_10_1001_jamadermatol_2023_1494 crossref_primary_10_1111_jdv_20371 crossref_primary_10_2217_pme_2020_0048 crossref_primary_10_1016_j_jdin_2023_01_025 crossref_primary_10_3390_cancers15010042 crossref_primary_10_1093_ced_llae112 crossref_primary_10_1245_s10434_022_11725_8 crossref_primary_10_1111_exd_14705 crossref_primary_10_5694_mja2_52443 crossref_primary_10_3390_diagnostics10090632 crossref_primary_10_3390_jpm11100951 crossref_primary_10_5694_mja2_51910 crossref_primary_10_1001_jamadermatol_2023_1485 crossref_primary_10_1007_s10278_024_01202_x crossref_primary_10_1007_s40846_021_00643_x crossref_primary_10_1080_09546634_2022_2038772 crossref_primary_10_1111_cup_14635 crossref_primary_10_1111_ddg_14233_g crossref_primary_10_1001_jamadermatol_2018_1764 crossref_primary_10_1001_jamadermatol_2021_4915 crossref_primary_10_1007_s00428_020_02817_5 crossref_primary_10_1111_cup_14078 crossref_primary_10_1007_s00105_025_05468_2 crossref_primary_10_1111_cup_14083 crossref_primary_10_1038_s41598_019_52937_5 crossref_primary_10_1001_jamanetworkopen_2022_50613 crossref_primary_10_1177_21501319251344423 crossref_primary_10_1097_DSS_0000000000002695 crossref_primary_10_3389_fmed_2020_591952 crossref_primary_10_3390_cancers13153864 crossref_primary_10_1016_j_jaad_2020_05_071 crossref_primary_10_1111_his_15187 crossref_primary_10_1111_jdv_17189 crossref_primary_10_1016_j_prp_2024_155543 crossref_primary_10_1016_j_jaad_2018_06_058 crossref_primary_10_1001_jamadermatol_2022_2932 crossref_primary_10_1111_ddg_14233 crossref_primary_10_7759_cureus_69818 crossref_primary_10_1007_s00105_018_4204_8 crossref_primary_10_1016_j_jid_2019_06_126 crossref_primary_10_1097_DSS_0000000000001256 crossref_primary_10_1097_DSS_0000000000001498 crossref_primary_10_1001_jamadermatol_2025_3077 crossref_primary_10_1016_j_jid_2018_11_024 crossref_primary_10_1016_j_jid_2021_11_025 crossref_primary_10_1038_bjc_2017_477
Cites_doi	10.1097/PAS.0000000000000198 pmid:24618612 10.1016/j.jaad.2009.09.043 pmid:20303612 10.1056/NEJM197810262991705 pmid:692598 10.1016/j.jaad.2016.04.052 pmid:27189823 10.1111/cup.12751 pmid:27247109 10.1038/nrc.2016.37 pmid:27125352 10.3109/02844319509034330 pmid:7569811 10.1056/NEJM196310312691801 pmid:14056638 10.1016/j.jaad.2013.07.027 pmid:24176521 10.1016/0895-4356(94)90193-7 pmid:7730893 10.1016/j.jaad.2014.07.056 pmid:25239732 10.1016/j.jaad.2012.06.034 pmid:22892284 10.1016/j.jaad.2015.09.008 pmid:26514601 10.1038/jid.1993.55 pmid:8440913 10.1001/jama.2015.1405 pmid:25781441 10.1056/NEJM199412013312206 pmid:7969300 10.1016/S0190-9622(08)81499-5 pmid:8176008 10.1016/S0046-8177(96)90157-4 pmid:8666360 10.1200/JCO.1996.14.4.1218 pmid:8648377 10.1016/0895-4356(92)90128-A pmid:1607896 10.1056/NEJMoa1502583 pmid:26559571 10.1002/path.1061 pmid:11920743 10.2340/00015555-1517 pmid:23306667 10.1001/archderm.1996.03890320029004 pmid:8712837 10.1001/jamadermatol.2014.4362 pmid:25607470 10.1148/radiol.11110618 pmid:22357893 10.1016/S0959-8049(03)00325-3 pmid:12932663 10.1016/S0190-9622(96)80061-2 pmid:8601651 10.1016/0021-9681(85)90016-5 pmid:3894405 10.1097/00000478-200312000-00011 pmid:14657718 10.1136/bmj.38516.649537.E0 pmid:16081427 10.1001/archderm.1997.03890440019002 pmid:9267239 10.1002/path.1711630310 pmid:2013827 10.1136/jcp.50.3.202 pmid:9155669 10.1002/cncr.10768 pmid:12209696 10.1046/j.1365-2559.1996.d01-464.x pmid:8803593 10.1159/000336886 pmid:22433231 10.1016/S0046-8177(99)90193-4 pmid:10333219 10.1007/s10278-015-9836-y pmid:26546178 10.1097/SLA.0b013e31819ed973 pmid:19300224 pmid:7810353 10.1016/0190-9622(92)70248-E pmid:1430397 10.1001/archderm.138.5.625 pmid:12020223 10.7326/M15-0964 pmid:26999810 10.1111/j.1365-2559.1984.tb02388.x pmid:6519646 10.1136/jcp.49.1.79 pmid:8666692 pmid:26559597 10.7326/0003-4819-157-7-201210020-00002 pmid:23027317 pmid:21876845 10.1016/S0738-3991(99)00069-5 pmid:10705065 10.1097/00008469-199810000-00005 pmid:9884886 10.1245/s10434-014-3682-x pmid:24748128
ContentType	Journal Article
Copyright	Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Copyright: 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2017 BMJ
Copyright_xml	– notice: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to – notice: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. – notice: Copyright: 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions – notice: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2017 BMJ
DBID	9YT ACMMV AAYXX CITATION CGR CUY CVF ECM EIF NPM 3V. 7RV 7X7 7XB 88I 8AF 8FE 8FH 8FI 8FJ 8FK 8G5 ABUWG AFKRA AN0 ASE AZQEC BBNVY BENPR BHPHI BTHHO CCPQU DWQXO FPQ FYUFA GHDGH GNUQQ GUQSH HCIFZ K6X K9. KB0 LK8 M2O M2P M7P MBDVC NAPCQ PHGZM PHGZT PJZUB PKEHL PPXIY PQEST PQGLB PQQKQ PQUKI PRINS Q9U 7X8 5PM
DOI	10.1136/bmj.j2813
DatabaseName	BMJ Open Access Journals BMJ Journals:Open Access CrossRef Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed ProQuest Central (Corporate) Nursing & Allied Health Database Health & Medical Collection ProQuest Central (purchase pre-March 2016) Science Database (Alumni Edition) STEM Database ProQuest SciTech Collection ProQuest Natural Science Collection ProQuest Hospital Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) Research Library (Alumni) ProQuest Central (Alumni) ProQuest Central UK/Ireland British Nursing Database British Nursing Index ProQuest Central Essentials - QC Biological Science Collection ProQuest Central Natural Science Collection BMJ Journals ProQuest One ProQuest Central British Nursing Index (BNI) (1985 to Present) Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student ProQuest Research Library SciTech Premium Collection British Nursing Index ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Database (Alumni Edition) ProQuest Biological Science Collection Research Library Science Database (ProQuest) Biological Science Database Research Library (Corporate) Nursing & Allied Health Premium ProQuest Central Premium ProQuest One Academic ProQuest Health & Medical Research Collection ProQuest One Academic Middle East (New) ProQuest One Health & Nursing ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Applied & Life Sciences ProQuest One Academic (retired) ProQuest One Academic UKI Edition ProQuest Central China ProQuest Central Basic MEDLINE - Academic PubMed Central (Full Participant titles)
DatabaseTitle	CrossRef MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) Research Library Prep ProQuest Central Student ProQuest One Academic Middle East (New) ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest AP Science ProQuest Central (Alumni Edition) SciTech Premium Collection ProQuest One Community College ProQuest One Health & Nursing Research Library (Alumni Edition) ProQuest Natural Science Collection ProQuest Central China ProQuest Central ProQuest One Applied & Life Sciences ProQuest Health & Medical Research Collection Health Research Premium Collection Natural Science Collection ProQuest Central Korea Health & Medical Research Collection Biological Science Collection ProQuest Research Library ProQuest Central (New) ProQuest Science Journals (Alumni Edition) ProQuest Biological Science Collection ProQuest Central Basic ProQuest Science Journals ProQuest One Academic Eastern Edition British Nursing Index with Full Text British Nursing Index ProQuest Nursing & Allied Health Source ProQuest Hospital Collection Health Research Premium Collection (Alumni) Biological Science Database ProQuest SciTech Collection ProQuest Hospital Collection (Alumni) Nursing & Allied Health Premium ProQuest Health & Medical Complete ProQuest One Academic UKI Edition BMJ Journals ProQuest Nursing & Allied Health Source (Alumni) ProQuest One Academic ProQuest One Academic (New) ProQuest Central (Alumni) MEDLINE - Academic
DatabaseTitleList	Research Library Prep MEDLINE MEDLINE - Academic
Database_xml	– sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database
DeliveryMethod	fulltext_linktorsrc
Discipline	Medicine
EISSN	1756-1833
ExternalDocumentID	PMC5485913 28659278 10_1136_bmj_j2813 bmj
Genre	Multicenter Study Journal Article
GeographicLocations	United States--US
GeographicLocations_xml	– name: United States--US
GrantInformation_xml	– fundername: NCI NIH HHS grantid: P30 CA023108
GroupedDBID	23N 39C 4.4 40O 53G 5GY 7RV 7X7 88I 8AF 8F7 8FE 8FH 8FI 8FJ 8G5 9YT AACGO AANCE AAWJN ABBHK ABIVO ABJNI ABPLY ABTLG ABUWG ABVAJ ABXSQ ACGFS ACGOD ACHIC ACMFJ ACMMV ACPRK ADQXQ ADULT AEUPB AEXZC AFKRA AGFXO AHMBA AHNKE AHQMW AJYBZ ALIPV ALMA_UNASSIGNED_HOLDINGS AQVQM AZQEC BBNVY BENPR BHPHI BPHCQ BTHHO C45 CCPQU CS3 DCCCD DWQXO EBS EJD F5P FYUFA GNUQQ GUQSH H13 HAJ HCIFZ HMCUK HZ~ IPSME JAAYA JBMMH JENOY JHFFW JKQEH JLS JLXEF JPM JSG JST L7B LK8 M2O M2P M7P NAPCQ NXWIF O9- OVD PHGZT PQQKQ PROAC R53 RHI RMJ RV8 SA0 TEORI UKHRP VVN WOQ YFH YQY AAYXX AFFHD AN0 CITATION IAG IBB IMI PHGZM PJZUB PPXIY PQGLB 0R~ CGR CUY CVF ECM EIF NPM 3V. 7XB 8FK ASE FPQ K6X K9. MBDVC PKEHL PQEST PQUKI PRINS PUEGO Q9U 7X8 5PM
ID	FETCH-LOGICAL-b498t-516a6d2fd66eb9dd61d13c21bd77949500250a034151c5f489725b07dba7175b3
IEDL.DBID	7RV
ISICitedReferencesCount	335
ISICitedReferencesURI	http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000404724400002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN	0959-8138 1756-1833
IngestDate	Tue Nov 04 01:58:16 EST 2025 Tue Sep 30 21:35:17 EDT 2025 Mon Sep 08 13:52:54 EDT 2025 Thu Apr 03 07:01:41 EDT 2025 Sat Nov 29 06:42:52 EST 2025 Tue Nov 18 21:07:14 EST 2025 Thu Apr 24 23:08:44 EDT 2025
IsDoiOpenAccess	true
IsOpenAccess	true
IsPeerReviewed	true
IsScholarly	true
Language	English
License	This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
LinkModel	DirectLink
MergedId	FETCHMERGED-LOGICAL-b498t-516a6d2fd66eb9dd61d13c21bd77949500250a034151c5f489725b07dba7175b3
Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
OpenAccessLink	https://pubmed.ncbi.nlm.nih.gov/PMC5485913
PMID	28659278
PQID	1914434086
PQPubID	2043523
ParticipantIDs	pubmedcentral_primary_oai_pubmedcentral_nih_gov_5485913 proquest_miscellaneous_1914847595 proquest_journals_1914434086 pubmed_primary_28659278 crossref_primary_10_1136_bmj_j2813 crossref_citationtrail_10_1136_bmj_j2813 bmj_primary_10_1136_bmj_j2813
PublicationCentury	2000
PublicationDate	20170628 2017-06-28 2017-Jun-28
PublicationDateYYYYMMDD	2017-06-28
PublicationDate_xml	– month: 6 year: 2017 text: 20170628 day: 28
PublicationDecade	2010
PublicationPlace	England
PublicationPlace_xml	– name: England – name: London
PublicationTitle	BMJ (Online)
PublicationTitleAlternate	BMJ
PublicationYear	2017
Publisher	BMJ Publishing Group LTD BMJ Publishing Group Ltd
Publisher_xml	– name: BMJ Publishing Group LTD – name: BMJ Publishing Group Ltd
References	2011; 357 1997; 357 1994; 357 1963; 357 2000; 357 2005; 357 2002; 357 1995; 357 1998; 357 1978; 357 2003; 357 1991; 357 2014; 357 2009; 357 2015; 357 2010; 357 2013; 357 1992; 357 1984; 357 1985; 357 2016; 357 1996; 357 2012; 357 1999; 357 1993; 357 28790163 - BMJ. 2017 Aug 8;358:j3798
References_xml	– volume: 357 start-page: 934 year: 2014 publication-title: Am J Surg Pathol doi: 10.1097/PAS.0000000000000198 pmid:24618612 – volume: 357 start-page: 751 year: 2010 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2009.09.043 pmid:20303612 – volume: 357 start-page: 926 year: 1978 publication-title: N Engl J Med doi: 10.1056/NEJM197810262991705 pmid:692598 – volume: 357 start-page: 356 year: 2016 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2016.04.052 pmid:27189823 – volume: 357 start-page: 830 year: 2016 publication-title: J Cutan Pathol doi: 10.1111/cup.12751 pmid:27247109 – volume: 357 start-page: 345 year: 2016 publication-title: Nat Rev Cancer doi: 10.1038/nrc.2016.37 pmid:27125352 – volume: 357 start-page: 141 year: 1995 publication-title: Scand J Plast Reconstr Surg Hand Surg doi: 10.3109/02844319509034330 pmid:7569811 – volume: 357 start-page: 929 year: 1963 publication-title: N Engl J Med doi: 10.1056/NEJM196310312691801 pmid:14056638 – volume: 357 start-page: 131 year: 2014 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2013.07.027 pmid:24176521 – volume: 357 start-page: 897 year: 1994 publication-title: J Clin Epidemiol doi: 10.1016/0895-4356(94)90193-7 pmid:7730893 – volume: 357 start-page: 1204 year: 2014 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2014.07.056 pmid:25239732 – volume: 357 start-page: 119 year: 2013 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2012.06.034 pmid:22892284 – volume: 357 start-page: 75 year: 2016 publication-title: J Am Acad Dermatol doi: 10.1016/j.jaad.2015.09.008 pmid:26514601 – volume: 357 start-page: 318S year: 1993 publication-title: J Invest Dermatol doi: 10.1038/jid.1993.55 pmid:8440913 – volume: 357 start-page: 1122 year: 2015 publication-title: JAMA doi: 10.1001/jama.2015.1405 pmid:25781441 – volume: 357 start-page: 1493 year: 1994 publication-title: N Engl J Med doi: 10.1056/NEJM199412013312206 pmid:7969300 – volume: 357 start-page: 707 year: 1994 publication-title: J Am Acad Dermatol doi: 10.1016/S0190-9622(08)81499-5 pmid:8176008 – volume: 357 start-page: 528 year: 1996 publication-title: Hum Pathol doi: 10.1016/S0046-8177(96)90157-4 pmid:8666360 – volume: 357 start-page: 1218 year: 1996 publication-title: J Clin Oncol doi: 10.1200/JCO.1996.14.4.1218 pmid:8648377 – volume: 357 start-page: 567 year: 1992 publication-title: J Clin Epidemiol doi: 10.1016/0895-4356(92)90128-A pmid:1607896 – volume: 357 start-page: 1926 year: 2015 publication-title: N Engl J Med doi: 10.1056/NEJMoa1502583 pmid:26559571 – volume: 357 start-page: 459 year: 2002 publication-title: J Pathol doi: 10.1002/path.1061 pmid:11920743 – volume: 357 start-page: 411 year: 2013 publication-title: Acta Derm Venereol doi: 10.2340/00015555-1517 pmid:23306667 – volume: 357 start-page: 881 year: 1996 publication-title: Arch Dermatol doi: 10.1001/archderm.1996.03890320029004 pmid:8712837 – volume: 357 start-page: 477 year: 2015 publication-title: JAMA Dermatol doi: 10.1001/jamadermatol.2014.4362 pmid:25607470 – volume: 357 start-page: 941 year: 2012 publication-title: Radiology doi: 10.1148/radiol.11110618 pmid:22357893 – volume: 357 start-page: 1861 year: 2003 publication-title: Eur J Cancer doi: 10.1016/S0959-8049(03)00325-3 pmid:12932663 – volume: 357 start-page: 618 year: 1996 publication-title: J Am Acad Dermatol doi: 10.1016/S0190-9622(96)80061-2 pmid:8601651 – volume: 357 start-page: 619 year: 1985 publication-title: J Chronic Dis doi: 10.1016/0021-9681(85)90016-5 pmid:3894405 – volume: 357 start-page: 1571 year: 2003 publication-title: Am J Surg Pathol doi: 10.1097/00000478-200312000-00011 pmid:14657718 – volume: 357 start-page: 481 year: 2005 publication-title: BMJ doi: 10.1136/bmj.38516.649537.E0 pmid:16081427 – volume: 357 start-page: 953 year: 1997 publication-title: Arch Dermatol doi: 10.1001/archderm.1997.03890440019002 pmid:9267239 – volume: 357 start-page: 245 year: 1991 publication-title: J Pathol doi: 10.1002/path.1711630310 pmid:2013827 – volume: 357 start-page: 202 year: 1997 publication-title: J Clin Pathol doi: 10.1136/jcp.50.3.202 pmid:9155669 – volume: 357 start-page: 1094 year: 2002 publication-title: Cancer doi: 10.1002/cncr.10768 pmid:12209696 – volume: 357 start-page: 497 year: 1996 publication-title: Histopathology doi: 10.1046/j.1365-2559.1996.d01-464.x pmid:8803593 – volume: 357 start-page: 51 year: 2012 publication-title: Dermatology doi: 10.1159/000336886 pmid:22433231 – volume: 357 start-page: 513 year: 1999 publication-title: Hum Pathol doi: 10.1016/S0046-8177(99)90193-4 pmid:10333219 – volume: 357 start-page: 243 year: 2016 publication-title: J Digit Imaging doi: 10.1007/s10278-015-9836-y pmid:26546178 – volume: 357 start-page: 641 year: 2009 publication-title: Ann Surg doi: 10.1097/SLA.0b013e31819ed973 pmid:19300224 – volume: 357 start-page: 371 year: 1994 publication-title: J Am Board Fam Pract doi: pmid:7810353 – volume: 357 start-page: 741 year: 1992 publication-title: J Am Acad Dermatol doi: 10.1016/0190-9622(92)70248-E pmid:1430397 – volume: 357 start-page: 625 year: 2002 publication-title: Arch Dermatol doi: 10.1001/archderm.138.5.625 pmid:12020223 – volume: 357 start-page: 649 year: 2016 publication-title: Ann Intern Med doi: 10.7326/M15-0964 pmid:26999810 – volume: 357 start-page: 717 year: 1984 publication-title: Histopathology doi: 10.1111/j.1365-2559.1984.tb02388.x pmid:6519646 – volume: 357 start-page: 79 year: 1996 publication-title: J Clin Pathol doi: 10.1136/jcp.49.1.79 pmid:8666692 – volume: 357 start-page: 317 year: 2016 publication-title: J Am Acad Dermatol doi: pmid:26559597 – volume: 357 start-page: 461 year: 2012 publication-title: Ann Intern Med doi: 10.7326/0003-4819-157-7-201210020-00002 pmid:23027317 – volume: 357 start-page: 656079 year: 2011 publication-title: Patholog Res Int doi: pmid:21876845 – volume: 357 start-page: 59 year: 2000 publication-title: Patient Educ Couns doi: 10.1016/S0738-3991(99)00069-5 pmid:10705065 – volume: 357 start-page: 397 year: 1998 publication-title: Eur J Cancer Prev doi: 10.1097/00008469-199810000-00005 pmid:9884886 – volume: 357 start-page: 2245 year: 2014 publication-title: Ann Surg Oncol doi: 10.1245/s10434-014-3682-x pmid:24748128 – reference: 28790163 - BMJ. 2017 Aug 8;358:j3798
SSID	ssj0002378965
Score	2.6523137
Snippet	Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility... To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions. Observer accuracy and reproducibility study. 10 US... Objective To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions. Design Observer accuracy and reproducibility... Objective To quantify the accuracy and reproducibility of pathologists' diagnoses of melanocytic skin lesions.Design Observer accuracy and reproducibility... Objective To quantify the accuracy and reproducibility of pathologists’ diagnoses of melanocytic skin lesions. Design Observer accuracy and reproducibility...
SourceID	pubmedcentral proquest pubmed crossref bmj
SourceType	Open Access Repository Aggregation Database Index Database Enrichment Source Publisher
StartPage	j2813
SubjectTerms	Accuracy Adult Biopsy Classification Clinical Competence - statistics & numerical data Diagnosis Diagnosis, Differential Diagnostic Errors Evolution & development Histology Humans Lymphatic system Medical diagnosis Melanoma Melanoma - diagnosis Melanoma, Cutaneous Malignant Middle Aged Nevus Nevus, Pigmented - diagnosis Observer Variation Pathology Pathology, Clinical - standards Physicians Reproducibility Reproducibility of Results Reviews Skin cancer Skin diseases Skin Neoplasms - diagnosis United States Visual perception
Title	Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study
URI	http://bmj.com/content/357/bmj.j2813.full https://www.ncbi.nlm.nih.gov/pubmed/28659278 https://www.proquest.com/docview/1914434086 https://www.proquest.com/docview/1914847595 https://pubmed.ncbi.nlm.nih.gov/PMC5485913
Volume	357
WOSCitedRecordID	wos000404724400002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText	1
inHoldings	1
isFullTextHit
isPrint
journalDatabaseRights	– providerCode: PRVPQU databaseName: Biological Science Database customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: M7P dateStart: 19940108 isFulltext: true titleUrlDefault: http://search.proquest.com/biologicalscijournals providerName: ProQuest – providerCode: PRVPQU databaseName: Health & Medical Collection customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: 7X7 dateStart: 19940108 isFulltext: true titleUrlDefault: https://search.proquest.com/healthcomplete providerName: ProQuest – providerCode: PRVPQU databaseName: Nursing & Allied Health Database customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: 7RV dateStart: 19940108 isFulltext: true titleUrlDefault: https://search.proquest.com/nahs providerName: ProQuest – providerCode: PRVPQU databaseName: ProQuest Central customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: BENPR dateStart: 19940108 isFulltext: true titleUrlDefault: https://www.proquest.com/central providerName: ProQuest – providerCode: PRVPQU databaseName: Research Library customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: M2O dateStart: 19940108 isFulltext: true titleUrlDefault: https://search.proquest.com/pqrl providerName: ProQuest – providerCode: PRVPQU databaseName: Science Database (ProQuest) customDbUrl: eissn: 1756-1833 dateEnd: 20250928 omitProxy: false ssIdentifier: ssj0002378965 issn: 0959-8138 databaseCode: M2P dateStart: 19940108 isFulltext: true titleUrlDefault: https://search.proquest.com/sciencejournals providerName: ProQuest
link	http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1Lb9QwELagRYgL70egrQxCgkva2PGTCwLUikuXqAK0t8iviK26ybLJVuy_x3aygQXUC5dREk8cSzP2zNiTbwB4SZii3syjkKnGUmKQTqVGJM19FJdxxRRzNhab4JOJmE5lMWy4tUNa5WZNjAu1bUzYIz8KOGQkJ94Df7v4noaqUeF0dSihcR3somC7vT7zs6_jHgvOuZCMDoBCKGdHen5-eI5FLGbgr7eN0V8e5p-Jkr9ZnpM7_zvmu-D24HPCd72S3APXXH0f3DwdTtUfgB-F6vpFsO3aV9D22XezFjYVnNWXKmS4w7m7UHUzV1DVdrgxa98hXIS6P5XrNal9AxsdNnrdEipjVktl1vGNAJ4ZsGX7ZNw1jLC2D8GXk-PPHz6mQ0WGVBMputSLVTGLK8uY09JahizKDUbacj-vJY0elcq8ZaTI0IoIyTHVGbda-bCR6vwR2Kmb2j0BsNJEsUoa7PKMWIeUEZQboThhxGhiE7DvBVQuesyNMsYqOSvDsyjABLzeiK40A5x5qKpx8S_WFyPrFf3tbWRYDtO4LX8JMAHPx2Y_AcOpiqpds-p5REBNpAl43KvL-JXw26_EXCSAbynSyBDAvbdb6tm3CPLtI0kqUf706mE9A7dw8DMylmKxB3a65crtgxvmspu1y4M4GwKd8kjFAdh9fzwpzvzdKf4UaREoL34CqlsfEA
linkProvider	ProQuest
linkToHtml	http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Lb9QwEB6VgoAL70egBYNAcAlNHMcPJIQQULVqu-qhSHsLfkVs1U2WTbawf4rfiJ0XLKDeeuCWxBPHST6PZ-zxNwDPCJWpG-ZjH6lGQ6JjFQoVkzBxXlzEJJXUmibZBBuN-HgsDtfgR78XxodV9jqxUdSm1H6OfMvzkJGEOAv87exr6LNG-dXVPoVGC4s9u_zmXLbqze4H93-fY7z98ej9TthlFQgVEbwOXdMkNTg3lFoljKGxiRONY2WYw6ZIG6tARk67p7FOc8IFw6mKmFHSuT6pSly9F-Ci0-PMh5CxMRvmdHDCuKBpR2AUJ3RLTY9fHWPeJE9wx6uD318W7Z-Bmb-NdNvX_7dvdAOudTY1etd2gpuwZotbcPmgixq4Dd8PZd0q-aquXiDTRhdOKlTmaFKcSh_Bj6b2RBblVCJZmO5EL12FaObzGuW27SnVa1QqP5Ft50hqvZhLvWzu8OSgnju3DTZeooa29w58Opf3vgvrRVnY-4ByRSTNhcY2iYixsdQ8ZZpLRijRipgANh0gslnLKZI1vlhCM3-tAUwAL3uoZLqja_dZQ07-Jfp0ED2jvo0eM1mnpqrsF2ACeDIUOwXjV41kYctFK8M9K2QawL0WnsNT_LZmgRkPgK0AdxDw5OWrJcXkS0Ni7jzlVMTJg7Ob9Riu7Bwd7Gf7u6O9h3AVe5sqoiHmG7Bezxd2Ey7p03pSzR81PRHB5_OG9U_EwXL7
linkToPdf	http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V1Lb9QwEB6VgiouvB-BFgwCwSU0dvxIkBBClBVV6WoPIPUW_IrYqpssm2xh_xq_DjsvWEC99cAtiSeOk3wez9jjbwCeUC6ZG-axj1TjIdVYhanCNIydFxcJySW3pkk2Icbj5OgonWzAj34vjA-r7HVio6hNqf0c-a7nIaMx9XmB8i4sYrI3ej3_GvoMUn6ltU-n0ULkwK6-OfeterW_5_71U0JG7z6-fR92GQZCRdOkDl0zJTckN5xblRrDscGxJlgZ4XCassZCkJHT9AxrltMkFYSpSBglnRvEVOzqvQAXBWXM965DMhnmd0gskpSzjswIx3xXzY5fHJOkSaTgjtcHwr-s2z-DNH8b9UZX_-fvdQ2udLY2etN2juuwYYsbsHXYRRPchO8TWbfKv6qrZ8i0UYfTCpU5mhan0kf2o5k9kUU5k0gWpjvRK1chmvt8R7lte1D1EpXKT3DbBZJaLxdSr5o7PGmo59Rtg5BXqKHzvQWfzuW9b8NmURb2LqBcUcnzVBMbR9RYLHXChE6koJxqRU0AOw4c2bzlGskaHy3mmb_WgCeA5z1sMt3RuPtsIif_En08iJ5R33aPn6xTX1X2CzwBPBqKneLxq0mysOWylUk8WyQL4E4L1eEpfrtzSkQSgFgD8SDgSc3XS4rpl4bc3HnQLMXxvbOb9RC2HJqzD_vjg_twmXhTK-IhSbZhs14s7Q5c0qf1tFo8aDolgs_njeqf2Nx7yA
openUrl	ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Pathologists%E2%80%99+diagnosis+of+invasive+melanoma+and+melanocytic+proliferations%3A+observer+accuracy+and+reproducibility+study&rft.jtitle=BMJ.+British+medical+journal+%28Clinical+research+ed.%29&rft.au=Elmore%2C+Joann+G&rft.au=Barnhill%2C+Raymond+L&rft.au=Elder%2C+David+E&rft.au=Longton%2C+Gary+M&rft.date=2017-06-28&rft.issn=0959-8138&rft.eissn=1756-1833&rft.spage=j2813&rft_id=info:doi/10.1136%2Fbmj.j2813&rft.externalDBID=n%2Fa&rft.externalDocID=10_1136_bmj_j2813
thumbnail_l	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0959-8138&client=summon
thumbnail_m	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0959-8138&client=summon
thumbnail_s	http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0959-8138&client=summon