A study published online October 17, 2026 in the Journal of the American Academy of Dermatology examines how second-opinion pathology reviews before dermatologic surgery affect clinical treatment decisions. The paper, led by Sarah Ghadersohi with senior authors including Karen L. Connolly of Memorial Sloan Kettering Cancer Center, asks a deceptively simple question: when a dermatologic surgeon re-reads the slides before operating, does the treatment plan change?

The answer matters for every practice that treats skin cancer. Biopsy pathology is the foundation on which Mohs surgery, wide local excision and surveillance decisions rest. If the original read and the second read diverge, the surgical plan can shift — sometimes toward less surgery, sometimes toward more.

Who conducted the study?

The author list reads like a who's-who of dermatopathology and dermatologic surgery. Ghadersohi is joined by Michael J. Davis, Megan H. Trager, Kishwer Nehal, Nicholas Kurtansky, Klaus J. Busam, Elizabeth A. Quigley and Karen L. Connolly. The group spans both the pathology reading room and the operating suite, which is precisely the point: the study sits at the junction where a diagnosis becomes a procedure.

Busam is a dermatopathologist whose work on melanocytic tumors is widely cited, and Connolly and Nehal are established in dermatologic surgery. That combination lets the team evaluate both sides of the handoff between pathologist and surgeon — the diagnosis and the operation it triggers.

What does a second-opinion review address?

The title of the paper frames the outcome measure directly: clinical treatment impact. In dermatologic surgery, the pathology report dictates nearly everything downstream — margin choice, excision width, whether Mohs micrographic surgery is appropriate, and whether a patient needs sentinel lymph node discussion for melanoma with sufficient Breslow depth.

A second-opinion review is exactly what it sounds like. Before surgery, the treating team obtains the outside slides and re-reviews them, rather than relying solely on the original institution's diagnosis. Prior literature in dermatopathology has shown that such reviews can reclassify lesions, including melanocytic tumors and squamous lesions, at meaningful rates. This new JAAD work focuses that lens specifically on the presurgical setting and on what happens next for the patient.

The clinical stakes are easy to picture. A reclassified tumor can mean a wider margin, a different reconstruction, or cancellation of a planned procedure altogether. A downgrade can spare a patient an operation. An upgrade can move a patient from a simple excision to a staging workup.

Why publish this now?

The study appeared online on October 17, 2026, in JAAD, the field's highest-impact clinical journal. Timing like this usually signals that the editors see practice-level relevance — a question that dermatologists face weekly, not yearly.

Second-opinion review before dermatologic surgery has long been a habit at large referral centers, where outside pathology routinely arrives before the patient does. The open question is how often that habit changes management, and how practices without embedded dermatopathology should weigh the logistics of obtaining slides against the potential for a revised plan.

For community dermatologists, the practical calculus involves turnaround time, payer logistics and patient anxiety while slides travel between institutions. A quantified treatment-impact rate would let surgeons decide which cases — melanocytic, atypical squamous, or otherwise — justify the delay.

What should practicing dermatologists watch for?

The full paper carries the numbers: how many reviews changed the diagnosis, how many changed the planned surgery, and in which direction. Those figures will determine whether presurgical second-opinion review should be routine or reserved for selected tumor types.

Readers can find the study in the Journal of the American Academy of Dermatology, available online since October 17, 2026, under the title "Second-opinion pathology review prior to dermatologic surgery: Clinical treatment impact." As referral patterns concentrate complex skin-cancer care at surgical centers, evidence quantifying the management-level yield of slide re-review is likely to shape presurgical protocols for years to come.