Journal of Dermatology and Dermatologic Diseases

Misdiagnosis of Melanoma: A 7 Year Single-Center Analysis

Abstract

Slavomir Urbancek, Petra Fedorcova, Jela Tomkova1 and Roman Sutka

Background: Despite implementation of dermoscopy, the accuracy of diagnosing melanoma remains a challenge. The aim of this study was to retrospectively analyze cases of histologically confirmed melanoma, which were incorrectly diagnosed during initial evaluation.
Methods: A retrospective analysis of histologically diagnosed melanomas referred to the F.D. Roosevelt Hospital between 2008 and 2014, in which the initial diagnosis was incorrect. We evaluated their histological characteristics, localization of the lesion as well as the specialty of the physician who made the incorrect diagnosis.
Results: From a total of 936 histologicaly confirmed melanomas, 150 (16%) were diagnosed incorrectly. Of those, 26 (17.3%) were melanoma in situ. The average value of the Clark Ì�?s level of true melanomas was 3.49, with an average Breslow thickness of 3.09 mm. Sixty of the melanomas developed on the trunk and 55 on the extremities. Incorrectly diagnosed lesions included nevi in 80 cases, basal-cell carcinoma in 32, non-specific tumor in 16, pyogenic granuloma in 5, squamous-cell carcinoma in 5, haemangioma in 5, seborrheic keratosis in 4 cases, and histiocytoma, keratoacanthoma and cornu cutaneum each in 1 case. The diagnosis of melanoma was missed by a dermatologistin 85 cases, by a surgeon in 38 cases, and by a general practitioner in 2 cases. In the remaining 25 cases we were unable to identify the specialty of the physician who made the wrong diagnosis.
Conclusion: This analysis revealed a high proportion of melanomas that were missed during initial evaluation. The outcome of this study points to the need for better education in the field of diagnostics of melanocytic lesions for dermatologists, surgeons and primary care physicians. In addition, there is a need for periodic evaluation of diagnostic accuracy of dermatology centers using various tools (e.g. Melanoma Diagnostic Index). Continually increasing awareness of malignant melanoma in the general public is also very important.