Identification of Vertical Growth Phase in Malignant Melanoma: A Study of Interobserver Agreement

Ninety-four H&E-stained slides of malignant melanoma were circulated to 6 pathologists in 2 university departments. For each slide, the growth phase of the lesion, Breslow thickness, and Clark level were determined by each observer. The aims of the study were to evaluate agreement between nonspecialist pathologists in identifying the vertical growth phase in malignant melanoma and to compare agreement for the growth phase with agreement for Breslow thickness and the Clark level. Our results show that although overall agreement for the growth phase is moderate, agreement between experienced observers is good. In fact agreement for the growth phase among this group was equal to the agreement for Breslow thickness. Overall agreement for Breslow thickness also was good but for the Clark level was only fair. These findings suggest that if the predictive value of the vertical growth phase proves to be robust, it will be used with an acceptable level of accuracy in routine diagnostic practice.