Tosteson ANA, Tapp S, Titus LJ, et al. - In this decision-analytic model, selective second-opinion strategies for interpreting melanocytic skin lesions had the potential to enhance diagnostic accuracy while decreasing costs when compared with no second opinions or universal second opinions.

• The decision-analytic model parameters were based on 187 pathologists' diagnostic interpretations of 240 cases, which were compared with reference panel diagnoses.

• Without second opinions, 83.2% of diagnoses in the US were assessed to be accurate-that is, concordant with the reference diagnosis; with overinterpretation (8.0%) or underinterpretation (8.8%), and 16,850 misclassified diagnoses per 100,000 biopsies.

• All second-opinion strategies improved accuracy.

• When second opinions were universal (eg, performed on all biopsies), accuracy (87.4% concordance with 3.6% overinterpretation and 9.1% underinterpretation) and cost (an increase of more than $10 million per 100,000 biopsies per year) were highest.

• In comparison to no second opinions, a selective second-opinion strategy based on pathologists’ desire or institutional requirements for a second opinion was most accurate (86.5% concordance; 4.4% overinterpretation; 9.1% underinterpretation) and would save more than $1.9 million per 100,000 skin biopsies.

• All second-opinion strategies were related with lower overinterpretation but not underinterpretation as diagnostic accuracy improved.