Agreement among clinical, dermoscopic, and histopathological diagnoses of skin diseases

Abstract

Background. Skin diseases are common, especially in developing countries, and can substantially affect quality of life. Although many conditions can be diagnosed clinically, histopathological examination remains an important diagnostic reference in clinically uncertain cases. Objective. To assess the degree of agreement among clinical, dermoscopic, and histopathological diagnoses across a spectrum of cutaneous disorders. Materials and methods. This prospective, cross-sectional observational study was conducted in the Department of Dermatology and Venereology at Al-Sadr Teaching Hospital, Basra, Iraq, from 1 October 2024 to 30 September 2025. Four hundred consecutive patients with skin lesions for which clinical examination alone was considered inconclusive were included. Clinical assessment was followed by blinded dermoscopic evaluation, biopsy, and histopathological examination. One lesion and one biopsy per patient were analyzed. Results. The study included 400 patients (mean age 39.3 ± 20 years), with a slight male predominance (53%). Complete clinicopathological agreement, defined as histopathology matching the first clinical differential diagnosis, was present in 221/400 cases (55.25%). Partial agreement, defined as histopathology matching the second or third clinical differential diagnosis, was present in 52/400 cases (13.00%). Overall clinicopathological concordance with any of the first three clinical differential diagnoses was 273/400 (68.25%); 108/400 cases (27.00%) were discordant, and 19/400 (4.75%) were non-diagnostic on histopathology. Dermoscopic-histopathological agreement was reported in 184/400 cases (46.0%), and clinical-dermoscopic agreement in 228/400 (57.0%). Within the 273 concordant clinicopathological cases, histopathology matched the first, second, and third clinical differential diagnoses in 80.95%, 13.92%, and 5.13%, respectively. Conclusions. Clinical examination, dermoscopy, histopathology, and ancillary investigations provide complementary diagnostic information in clinically uncertain skin lesions. Histopathology remains an important reference method, while dermoscopy provides additional morphological information that should be interpreted together with clinical and histopathological findings.