Firstly Dr Caruso was working off images.
This a typical fallback position regarding any marks that have been revaluated as a result of images which were fought over for release being examined. If we take this approach, we might as well say that in any case, once a pathologist has determined what is or isn't present on a deceased person's body, that determination can never be challenged at a later date. Sorry but this is silly, not realistic and unworkable in terms of pathology governance.