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Discordance, accuracy and reproducibility study of pathologists’ diagnosis of melanoma and melanocytic tumors

Author

Listed:
  • Sarah Haggenmüller

    (German Cancer Research Center (DKFZ))

  • Christoph Wies

    (German Cancer Research Center (DKFZ)
    University Heidelberg)

  • Julia Abels

    (German Cancer Research Center (DKFZ))

  • Jana T. Winterstein

    (German Cancer Research Center (DKFZ)
    University Heidelberg)

  • Lukas Heinlein

    (German Cancer Research Center (DKFZ)
    University Heidelberg)

  • Carina Nogueira Garcia

    (German Cancer Research Center (DKFZ))

  • Jochen S. Utikal

    (Ruprecht-Karl University of Heidelberg
    German Cancer Research Center (DKFZ)
    DKFZ Hector Cancer Institute at the University Medical Center Mannheim)

  • Sebastian A. Wohlfeil

    (Ruprecht-Karl University of Heidelberg
    German Cancer Research Center (DKFZ)
    DKFZ Hector Cancer Institute at the University Medical Center Mannheim)

  • Friedegund Meier

    (Technische Universität Dresden)

  • Sarah Hobelsberger

    (Technische Universität Dresden)

  • Frank F. Gellrich

    (Technische Universität Dresden)

  • Mildred Sergon

    (Technische Universität Dresden
    Technische Universität Dresden)

  • Axel Hauschild

    (University Hospital (UKSH))

  • Lars E. French

    (LMU Munich
    Miller School of Medicine)

  • Lucie Heinzerling

    (LMU Munich
    CCC Alliance WERA)

  • Justin G. Schlager

    (LMU Munich)

  • Kamran Ghoreschi

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Max Schlaak

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Franz J. Hilke

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Gabriela Poch

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Sören Korsing

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Cosimo Sarfert

    (Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Carola Berking

    (CCC Alliance WERA)

  • Markus V. Heppt

    (CCC Alliance WERA)

  • Michael Erdmann

    (CCC Alliance WERA)

  • Sebastian Haferkamp

    (University Hospital Regensburg)

  • Konstantin Drexler

    (University Hospital Regensburg)

  • Dirk Schadendorf

    (University Hospital Essen)

  • Wiebke Sondermann

    (University Hospital Essen)

  • Matthias Goebeler

    (University Hospital Würzburg and National Center for Tumor Diseases (NCT) WERA Würzburg)

  • Bastian Schilling

    (Department of Dermatology)

  • Jakob Nikolas Kather

    (Technical University Dresden)

  • Stefan Fröhling

    (National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ))

  • Mar Llamas-Velasco

    (University Hospital La Princesa)

  • Luis C. Requena

    (Fundación Jiménez Díaz)

  • Gerardo Ferrara

    (Istituto Nazionale Tumori I.R.C.C.S. Fondazione ‘G. Pascale’)

  • Maite Fernandez-Figueras

    (Sant Cugat del Vallés)

  • Sylvie Fraitag

    (Assistance Publique des Hopitaux de Paris)

  • Cornelia S. L. Müller

    (Cytology and Molecular Diagnostics
    Saarland University)

  • Hans Starz

    (Dermpath München)

  • Heinz Kutzner

    (Dermatopathology Friedrichshafen)

  • Raymond Barnhill

    (Institut Curie)

  • Richard Carr

    (Warwick Hospital)

  • Kenneth S. Resnik

    (Institute for Dermatopathology)

  • Stephan Alexander Braun

    (Heinrich-Heine-University)

  • Tim Holland-Letz

    (German Cancer Research Center (DKFZ))

  • Titus J. Brinker

    (German Cancer Research Center (DKFZ))

Abstract

Accurate melanoma diagnosis is crucial for patient outcomes and reliability of AI diagnostic tools. We assess interrater variability among eight expert pathologists reviewing histopathological images and clinical metadata of 792 melanoma-suspicious lesions prospectively collected at eight German hospitals. Moreover, we provide access to the largest panel-validated dataset featuring dermoscopic and histopathological images with metadata. Complete agreement is achieved in 53.5% of cases (424/792), and a majority vote ( ≥ five pathologists) in 90.9% (720/792). Considerable discordance is observed for non-invasive melanomas (complete agreement in only 10/73 cases). The expert panel disagrees with the local pathologists’ and dermatologists’ diagnoses in 14.9% and 33.5% of cases, respectively. This variability highlights the diagnostic challenges of early-stage melanomas and the need to reconsider how ground truth is established in routine care and AI research. Including at least two pathologists or virtual panels may contribute to more consistent diagnostic results.

Suggested Citation

  • Sarah Haggenmüller & Christoph Wies & Julia Abels & Jana T. Winterstein & Lukas Heinlein & Carina Nogueira Garcia & Jochen S. Utikal & Sebastian A. Wohlfeil & Friedegund Meier & Sarah Hobelsberger & F, 2025. "Discordance, accuracy and reproducibility study of pathologists’ diagnosis of melanoma and melanocytic tumors," Nature Communications, Nature, vol. 16(1), pages 1-8, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-56160-x
    DOI: 10.1038/s41467-025-56160-x
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