Dermatopathology Appropriate Use Criteria

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In 2015, under the vision of then Society President, Dr. Dirk Elston, the Appropriate Use Criteria (AUC) Task Force was created to help guide dermatopathologists and inform their clinical colleagues in their use of ancillary studies performed in dermatopathology in specific clinical scenarios with overarching goal of producing high quality care, lowering costs and ensuring efficient use of laboratory resources.

The Task Force identified ancillary studies performed in dermatopathology encompassing four broad areas in which AUC could be developed. These included: lymphoproliferative, melanocytic, soft tissue, and other, which includes entities that do not fit into one of the aforementioned groups. Using the methodology developed by RAND/ UCLA, which combines best scientific evidence with expert opinion to develop patient-centered guidelines (appropriateness ratings), the Task Force explored 12 ancillary studies used in dermatopathology and 211 clinical scenarios that are commonly encountered in dermatopathology.

Appropriateness recommendations are published in the Journal of Cutaneous Pathology with an abbreviated version published in the Journal of the American Academy of Dermatology. The intent of the AUC is to provide guidance to physicians' in test selection in commonly encountered clinical scenarios. Still, the selected wording of the appropriateness ratings allows for individualization in diagnostic test selection, which is dependent on the clinical scenario at hand.

The Task Force was transitioned to a standing Committee in 2017, and along with working on dissemination of the developed AUC, the committee identified areas, which have a potential for misuse and are supported by evidence, which could be converted into recommendations for the Choosing Wisely Campaign. The recommended list was reviewed and approved by the ASDP Ethics Committee and Board of Directors.

Since then, the ASDP’s AUC in dermatopathology have been published in multiple peer-reviewed journals, in medical blogs and used to create recommendations that can be found on the on the Choosing Wisely website.

The ASDP is committed to making sure the AUC  stay relevant to dermatopathology and updates are already in the works.

Manuscripts with appropriateness recommendations:

Journal of Cutaneous Pathology

• Appropriate Use Criteria in Dermatopathology: Initial Recommendations from the American Society of Dermatopathology
• Muir‐Torre syndrome appropriate use criteria: Effect of patient age on appropriate use scores
• Appropriate use criteria for ancillary diagnostic testing in dermatopathology: New recommendations for 11 tests and 220 clinical scenarios from the American Society of Dermatopathology Appropriate Use Criteria Committee

Journal of the American Academy of Dermatology 

• Initial Recommendations from the American Society of Dermatopathology (abbreviated version) 

Literature review manuscripts:

• PAS and GMS utility in dermatopathology: Review of the current medical literature 
• Kappa and lambda immunohistochemistry and in situ hybridization in the evaluation of atypical cutaneous lymphoid infiltrates
• MYC gene amplification by fluorescence in situ hybridization and MYC protein expression by immunohistochemistry in the diagnosis of cutaneous angiosarcoma: Systematic review and appropriate use criteria
• TERT and TERT promoter in melanocytic neoplasms: Current concepts in pathogenesis, diagnosis, and prognosis 
• Views of dermatopathologists about clonality assays in the diagnosis of cutaneous T‐cell and B‐cell lymphoproliferative disorders 
• Review of the current medical literature and assessment of current utilization patterns regarding mismatch repair protein immunohistochemistry in cutaneous Muir–Torre syndrome‐associated neoplasms 
• Review of the current medical literature and assessment of current utilization patterns regarding human papillomavirus in situ hybridization and immunohistochemistry in dermatopathology 
• Evidence behind the use of molecular tests in melanocytic lesions and practice patterns of these tests by dermatopathologists 
• Review of the medical literature and assessment of current utilization patterns regarding the use of two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma

View all AUC publications in the Journal of Cutaneous Pathology

Interested in joining the ASDP Appropriate Use Criteria Committee? 
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