2nd Opinion Path

I am sometimes asked if a second opinion pathology report should be obtained. If there is any uncertainty by the initial pathologist they will automatically get a second opinion, so this is often done before the patient ever comes to my office. In general I will only get a second opinion pathology report if the original pathology report just doesn’t “make sense” to me; usually that there are too many internal consistencies in the original reading. Another situation is if the pathologist diagnoses an extremely rare variant melanoma. In such a case, I would try to send the slides to the pathologist most experienced in those rare cases. In my practice these have been very rare events.

Most of the time if people request a second opinion it is to “make sure it’s melanoma.” Obviously, nobody wants to be diagnosed with a dangerous cancer like melanoma. I don’t like getting a second opinion in that setting: unfortunately, you can’t choose your pathology outcome. When people request a second opinion for that reason, they are hoping that the second pathologist will disagree and say it isn’t a melanoma. Does that mean that the first pathologist was wrong? Can you ever be sure that the second pathologist, who gave you the report of your choice, was absolutely, unequivocally, correct?

In those cases it is always safest to go with the “worst case scenario”: always treat according to the worst (ie riskiest) pathologic reading. In other words, what are the highest risk melanoma features described in the pathology report(s), and use them to make treatment decisions. Don’t ever alter your treatment plan if a subsequent pathology reading lowers the apparent riskiness of the melanoma.

Eric D. Whitman, MD

Senior Editor, TheMelanomaCenter.com

(Publisher’s note: Dr. Whitman is currently finishing his first publication, which will expand this discussion on pathology report and give you insider-level knowledge on how to analyze and act on your pathology report and its findings. This e-publication will be available exclusively through TheMelanomaCenter.com. For more information, click here.)

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