{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T06:17:02Z","timestamp":1772864222788,"version":"3.50.1"},"reference-count":7,"publisher":"Walter de Gruyter GmbH","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2025-0001_abs_102\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We will explore the diagnostic similarities of spindle cell neoplasms and the attributed heuristics that lead to misdiagnosis biases. The biases explored will include availability bias and anchoring bias, with a discussion on the events leading to their formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0001_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 58-year-old African American male with a past medical history of well-controlled HIV presented to the dermatology clinic for a two-year history of several persistent skin nodules on his lower legs. One lesion on his left lateral calf, a 1.5\u202fcm dome-shaped nodule with a centralized keratinous plug, was suspicious for squamous cell carcinoma (SCC), prompting a shave biopsy. The dermatopathology report identified the lesion as dermatofibrosarcoma protuberans (DFSP) with CD34 positivity and the patient was referred for Mohs Micrographic Surgery. Frozen sections during Mohs surgery revealed concern for an alternative diagnosis, which was then confirmed as Kaposi Sarcoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0001_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case highlights the susceptibility of dermatology to misdiagnosis. Availability bias in the clinical setting led to an inadequate biopsy method. Further anchoring bias then potentially influenced histologic interpretation and management decisions. Insufficient appreciation of Kaposi Sarcoma development in the setting of well-controlled HIV also further influenced the diagnosis rendered. Mohs Surgery evaluation allowed for de-biased clinical and histologic assessment, correcting diagnosis. Several overlying factors, such as time pressures, knowledge gaps, and technique limitations, create a reliance on cognitive heuristics. Recognizing these external pressures can help clinicians enhance diagnostic accuracy by systematically considering alternative diagnoses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2025-0001","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T07:56:27Z","timestamp":1758700587000},"page":"130-132","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic pitfalls: how availability and anchoring biases lead to errors in dermatology"],"prefix":"10.1515","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-5252","authenticated-orcid":false,"given":"Austin S.","family":"Cusick","sequence":"first","affiliation":[{"name":"Division of Dermatology , Lehigh Valley Health Network , Allentown , PA , USA"},{"name":"Division of Dermatology , 24601 OhioHealth Riverside Methodist Hospital , Columbus , OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo","family":"Wan","sequence":"additional","affiliation":[{"name":"West Virginia School of Osteopathic Medicine , Lewisburg , WV , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela S.","family":"Casey","sequence":"additional","affiliation":[{"name":"Center for Surgical Dermatology , Westerville , OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Division of Hematology Ohio State University James Cancer Center , Columbus , OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie K.","family":"Fabbro","sequence":"additional","affiliation":[{"name":"Division of Dermatology , 24601 OhioHealth Riverside Methodist Hospital , Columbus , OH , USA"},{"name":"Rixis Dermatology , Columbus , OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"2026030615414918551_j_dx-2025-0001_ref_001","doi-asserted-by":"crossref","unstructured":"Elston, DM. Cognitive bias and medical errors. J\u00a0Am Acad Dermatol 2019;81:1249. https:\/\/doi.org\/10.1016\/j.jaad.2019.06.1284.","DOI":"10.1016\/j.jaad.2019.06.1284"},{"key":"2026030615414918551_j_dx-2025-0001_ref_002","doi-asserted-by":"crossref","unstructured":"Elston, DM. Availability bias and artificial intelligence. J\u00a0Am Acad Dermatol 2023;89:29\u201330. https:\/\/doi.org\/10.1016\/j.jaad.2019.07.051.","DOI":"10.1016\/j.jaad.2019.07.051"},{"key":"2026030615414918551_j_dx-2025-0001_ref_003","doi-asserted-by":"crossref","unstructured":"Jia, JL, Lester, JC. Anchoring bias and heuristics can perpetuate disparities in dermatology. J\u00a0Am Acad Dermatol 2023;88:265\u20136. https:\/\/doi.org\/10.1016\/j.jaad.2022.05.059.","DOI":"10.1016\/j.jaad.2022.05.059"},{"key":"2026030615414918551_j_dx-2025-0001_ref_004","doi-asserted-by":"crossref","unstructured":"Crum-Cianflone, NF, Hullsiek, KH, Ganesan, A, Weintrob, A, Okulicz, JF,\u00a0Agan, BK. Is Kaposi\u2019s sarcoma occurring at higher CD4 cell counts over the course of the HIV epidemic? AIDS Lond Engl 2010;24:2881\u20133. https:\/\/doi.org\/10.1097\/QAD.0b013e32833f9fb8.","DOI":"10.1097\/QAD.0b013e32833f9fb8"},{"key":"2026030615414918551_j_dx-2025-0001_ref_005","doi-asserted-by":"crossref","unstructured":"Hunt, PW, Lee, SA, Siedner, MJ. Immunologic biomarkers, morbidity, and mortality in treated HIV infection. J\u00a0Infect Dis 2016;214:S44\u201350. https:\/\/doi.org\/10.1093\/infdis\/jiw275.","DOI":"10.1093\/infdis\/jiw275"},{"key":"2026030615414918551_j_dx-2025-0001_ref_006","doi-asserted-by":"crossref","unstructured":"Choi, JH, Ro, JY. Cutaneous spindle cell neoplasms: Pattern-based diagnostic approach. Arch Pathol Lab Med 2018;142:958\u201372. https:\/\/doi.org\/10.5858\/arpa.2018-0112-RA.","DOI":"10.5858\/arpa.2018-0112-RA"},{"key":"2026030615414918551_j_dx-2025-0001_ref_007","doi-asserted-by":"crossref","unstructured":"Ko, CJ, Glusac, EJ. Cognitive bias in pathology, as exemplified in dermatopathology. Hum Pathol 2023;140:267\u201375. https:\/\/doi.org\/10.1016\/j.humpath.2023.03.003.","DOI":"10.1016\/j.humpath.2023.03.003"}],"container-title":["Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0001\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0001\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T15:43:07Z","timestamp":1772811787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2025-0001\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,25]]},"published-print":{"date-parts":[[2026,2,27]]}},"alternative-id":["10.1515\/dx-2025-0001"],"URL":"https:\/\/doi.org\/10.1515\/dx-2025-0001","relation":{},"ISSN":["2194-802X"],"issn-type":[{"value":"2194-802X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]}}}