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Journal of the American Academy of Dermatology
Volume 74, n° 2
page 317 (février 2016)
Doi : 10.1016/j.jaad.2015.09.037
accepted : 16 September 2015
Original Articles

How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

Patricia A. Carney, PhD a, b, , Paul D. Frederick, MPH, MBA e, Lisa M. Reisch, PhD e, Stevan Knezevich, MD, PhD g, Michael W. Piepkorn, MD f, h, Raymond L. Barnhill, MD i, j, David E. Elder, MB Chb, FRCPA k, Berta M. Geller, EdD l, Linda Titus, PhD m, Martin A. Weinstock, MD, PhD n, o, p, Heidi D. Nelson, MD, MPH c, d, q, Joann G. Elmore, MD, MPH e
a Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 
b Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon 
c Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon 
d Department of Medicine, Oregon Health and Science University, Portland, Oregon 
e Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington 
f Department of Medicine, University of Washington School of Medicine, Seattle, Washington 
g Pathology Associates, Clovis, California 
h Dermatopathology Northwest, Bellevue, Washington 
i Department of Pathology, University of California, Los Angeles, California 
j Department of Pathology, Institut Curie, Paris, France 
k Pathology, University of Pennsylvania, Philadelphia, Pennsylvania 
l Family Medicine, University of Vermont, Burlington, Vermont 
m Epidemiology and of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire 
n Dermatology and Epidemiology, Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island 
o Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island 
p Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island 
q Cancer Prevention and Screening, Providence Cancer Center, Providence Health and Services Oregon, Portland, Oregon 

Reprint requests: Patricia A. Carney, PhD, Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code: FM, Portland, OR 97239.

We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices.


We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits.


Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P  < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P  = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P  < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions.


Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents.


Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.

The full text of this article is available in PDF format.

Key words : additional histology testing, clinical interpretation, defensive clinical practice, dermatopathology, medical malpractice, melanoma

 Supported by the National Cancer Institute (R01 CA151306). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health.
 Survey available at
 Conflicts of interest: None declared.

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