Second opinion review is linked to error reduction and treatment changes in anatomic pathology.We sought to establish the rate of diagnostic discrepancy identified by second opinion dermatopathology review and the impact on surgical treatment.Cases referred for treatment of a malignant neoplasm diagnosed by an outside pathologist were reviewed. The external and internal second opinion dermatopathology reports were compared. Discordance in diagnosis, subtype and treatment change due to second opinion review was recorded. The referring pathologist's level of dermatopathology training was also documented.A total of 358 cases were included. Dermatopathology second opinion diagnosis was discordant with the outside diagnosis in 37/358 (10.3%) of cases. In 32/358 (8.9%) of cases , second opinion review resulted in a change in treatment, with 28/32 (87.5%) of these changes resulting in cancelled surgery. Dermatologists without dermatopathology fellowship training had the highest rate of discordant diagnoses compared to pathologists and dermatopathologists.This was a retrospective study at a tertiary care facility.Second opinion dermatopathology review is associated with identification of discordant diagnoses and a substantial impact on treatment, with both cancellation of surgery and augmented management. Secondary pathology review should be considered in high volume surgical practices.