AI Simplification of Dermatopathology Reports for Patients: Basic Versus Prompt-Engineered Approaches.

BACKGROUND: Patients struggle to comprehend dermatopathology reports. As artificial intelligence (AI) tools become more accessible, patients may use them to interpret reports; however, optimal approaches remain unexplored. OBJECTIVE: Evaluate whether prompt-engineered AI simplification of dermatopathology reports improves factualness, completeness, and reduces potential harm compared to basic AI usage. METHODS: Survey-based study (January-April 2025) of 52 US dermatology and dermatopathology professionals (70.3% response rate). Six fictitious dermatopathology reports were simplified using: (1) Basic ChatGPT-4.0 with simple prompt and (2) Custom "DermDecoder" GPT with structured 489-word prompt. Participants rated reports on 3-point Likert scales for factualness, completeness, and potential harm, with free-text responses analyzed thematically. RESULTS: Mean ratings ranged from 1.27 to 1.63 (factualness/completeness) and 1.31-1.83 (harmfulness), indicating "Agree" to "Mostly Agree" or "Completely Harmless" to "Mostly Harmless." DermDecoder performed significantly worse for completeness in psoriasis (t = -2.79, p = 0.007) and harmfulness in molluscum contagiosum (p = 0.049) and melanoma in situ (p = 0.048). Free-text analysis revealed Basic Prompt preserved details but lacked clinical context, while DermDecoder provided generic education disconnected from pathological findings. LIMITATIONS: Fictitious reports, small sample, evolving AI capabilities, and absence of patient perspectives. CONCLUSION: Prompt engineering offered no advantage over basic AI usage in balancing professional accuracy with patient accessibility, necessitating human-in-the-loop oversight for AI-generated explanations.