Molecular testing practices and perceptions among dermatopathologists

Background: We evaluated how dermatopathologists are employing molecular testing in the setting of neoplastic skin diseases, and assessed their opinions of the broader role and utility of molecular technologies in clinical practice. Methods: A 15-question online survey was sent to Fellows of the American Society of Dermatopathology in April 2017. Results: One hundred and thirty-six dermatopathologists completed the survey (response rate = 16%). A majority (94%) of respondents reported experience with one or more molecular testing strategies. Sixty-two percent of dermatopathologists order 12 or more molecular tests per year, while 5% of respondents order 2 or fewer assays per year. More frequent utilization of molecular testing is associated with relevant instruction during residency training (P =.009), primary board certification in pathology (P =.008), academic medical center affiliation (P = <.0001), higher volume clinical practice (P =.0004), presence of on-site clinical molecular pathology/cytogenetics laboratory (P =.007), and greater physician confidence incorporating test results into histopathological assessments (P = <.0001). Conclusions: Wider adoption of molecular testing in dermatopathology may be limited by factors such as physician training, test costs/insurance coverage, logistical issues and lack of evidence-based clinical practice guidelines. Dermatopathologists have concerns regarding clinical validity/utility and inappropriate/overuse of some molecular tests. The importance of longitudinal education in molecular technologies and their applications for trainee and practicing physicians is highlighted.