Histopathologic discordance in melanoma can have substantial impacts on patient care

Recommended guidelines for sentinel lymph node biopsy, follow-up, and surveillance for cutaneous melanoma are based upon clinicopathologic staging. In effect, the accuracy of melanoma staging to estimate metastatic risk is critical to subsequent care, neither under-treating or over-treating the patient based on their tumor. Traditional staging continues to evolve based on additional data regarding clinicopathologic features and clinical outcomes. However, such features are subject to inter-observer variability, which puts a limit on their ability to improve prognostication. Reported discordance rates between initial and subsequent pathology review consistently impact both staging and disease management. Newer molecular techniques, such as gene expression profiling, can be used to help define the biology of the primary melanoma tumor and the best course of action after definitive surgical treatment.