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Janine Wechsler, MD; Sylvie Bastuji-Garin, MD, PhD; Alain Spatz, MD; Christiane Bailly, MD; Bernard Cribier, MD, PhD; Lucile Andrac-Meyer, MD; Béatrice Vergier, MD; Sylvie Fraitag, MD; Olivier Verola, MD; Pierre Wolkenstein, MD, PhD; and the French Cutaneous Cancerology Group

Arch Dermatol. 2002;138:625-628.

Objective  To assess interrater reliability in the diagnosis of malignant melanoma in children.

Design, Setting, and Participants  We collected 85 slides of melanomas diagnosed in patients younger than 17 years through a network of dermatopathologists and dermatologists. The slides were classified into 3 categories: (1) slides from children with metastatic melanoma; (2) slides from disease-free children with a follow-up of less than 5 years; (3) slides from disease-free children with a follow-up of 5 years or longer. Category 1 was considered the gold standard. Four pairs of expert dermatopathologists reviewed the slides and classified them into melanoma, nevus (including Spitz nevus), or ambiguous tumors.

Intervention  None.

Main Outcome Measure  Concordance between pairs of experts.

Results  For category 1 slides (n = 20), the concordance was weak to moderate. For category 2 slides (n = 47), the concordance was weak. For category 3 slides (n = 18), the concordance was poor to moderate.

Conclusion  This study demonstrates that the reliability of diagnosis of melanoma in childhood is poor, even when submitted to experts.

From the Departments of Pathology at Hôpital Henri-Mondor, Créteil (Dr Wechsler), Institut Gustave Roussy, Villejuif (Dr Spatz), Centre Léon-Bérard, Lyon (Dr Bailly), Hôpital Nord, Marseille (Dr Andrac-Meyer), Hôpital Haut-Lévêque, Pessac (Dr Vergier), and Hôpital Necker-Enfants Malades (Dr Fraitag) and Hôpital Saint-Louis, Paris (Dr Verola); the Laboratory of Cutaneous Histopathology, University Hospital, Strasbourg (Dr Cribier); and the Departments of Public Heath (Dr Bastuji-Garin) and Dermatology (Dr Wolkenstein), Université Paris XII, Hôpital Henri-Mondor, Créteil (AP-HP), France.

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