Extent and consequences of physician delay in the diagnosis of acral melanoma

Metzger, Silke; Ellwanger, Ulf; Stroebel, Waltraud; Schiebel, Ursel; Rassner, G.; Fierlbeck, Gerhard

doi:10.1097/00008390-199804000-00014

Cited by 117 publications

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“…Since its first description in 1834 by Alexis Boyer, first surgeon to Napoleon, and the further definition of NAM characteristics in 1886 by Sir Jonathan Hutchinson, most authors continue to report a delayed diagnosis [17]. Most frequently NAM is misdiagnosed as a nail infection: mainly onychomycosis, subungual hematoma, traumatic injury or acquired nevus [8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Delayed diagnosis and advanced disease at the time of treatment may contribute to poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Because of its rarity, there are only a few studies focused specifically on NAM management [6,7]. Most authors include NAM in the group of cases of acral lentiginous melanoma [8,9]. We herein report our single institute experience regarding the prognosis of NAM patients in correlation with the tumors' histopathological characteristics and the surgical management.…”

Section: Introductionmentioning

confidence: 99%

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The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Dika

Patrizi²,

Fanti³

et al. 2016

Dermatology

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Introduction and Objectives: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. Materials and Methods: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. Results: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/<2 mm; p = 0.02), regression (p < 0.0001) and ulceration (p = 0.04). Regarding surgical management, Kaplan-Meier's test pointed out that performing functional surgery compared to disarticulation did not correlate with a better prognosis of patients (p = 0.08). Conclusions: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Dika

Patrizi²,

Fanti³

et al. 2016

Dermatology

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“…Obviously, patient education expecially in men older than 50 years about the existence of acral melanoma and regular skin surveillance remain headstones of secondary prevention [20,21]. Awareness that atypical presentations of acral melanoma may thus increase the rate of correct diagnosis and improve patient outcome for this potentially curable disease at its early stages.…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosed, Mistreated And Delay Diagnosed Acral Melanoma: The Atypical Presentations

Scalvenzi¹

2012

J Clin Exp Dermatol Res

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Background: Acral skin is the most common site of malignant melanoma in non-Caucasian population. Diagnosis in this anatomic site is often delayed because this area is not routinely examined by patients or primary physicians.Objective: To perform an earlier diagnosis underlining the importance of dermoscopy helping clinicians to differentiate this disease from the other lesions and biopsies will result in more timely diagnoses and improved survival.Methods: We present 6 case studies visited in our Department of Dermatology of Naples University between October 2010 and September 2012.Results: These lesions often mimic other entities like warts, calli, bacterial or fungal infections, foreign bodies, vascular lesions, blisters, melanocytic nevi, subungual hematomas, pyogenic granulomas, onychomycosis, keratoacanthomas, diabetic foot ulcers, traumatic lesions that can lead to misdiagnosis and mistreatment. Conclusions:Awareness of atypical presentations of acral melanoma may be important to decrease misdiagnosis rates and improve patient outcome.

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“…Despite comprising only 0.7-10% of all melanomas, it is the most frequent subtype in patients of African, Native American, and Asian descent and carries a poorer prognosis than similarly staged cutaneous melanomas [1,2,3,4,5,6]. Two-thirds of the SM cases present as longitudinal melanonychia (LM; a brown-black band of the nail plate), and these typically arise from the nail matrix and are melanoma in situ, as opposed to invasive melanoma [7].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

Halteh¹,

Scher²,

Artis³

et al. 2016

Skin Appendage Disord

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Importance: Subungual melanoma (SM) is a rare subtype of cutaneous melanoma but carries a worse prognosis than similarly staged cutaneous melanomas. Assessing patient knowledge of melanonychia is integral to early diagnosis of SM. Objectives: The aim of this paper is to determine patient knowledge of longitudinal melanonychia (LM) and warning signs for SM, frequency of nail self-examinations, and satisfaction of patients with their physician's nail examinations. Design, Setting, and Participants: We conducted a survey-based study of 363 random patients at Weill Cornell Medicine in New York, USA, performed at 3 different clinics: a general dermatology clinic (n = 167), a nail specialty clinic (n = 44), and a primary care clinic (n = 152). Main Outcomes and Measures: Knowledge of the ABCDEF mnemonic for SM was compared to the ABCD mnemonic for cutaneous melanoma. Analyses were performed for patient behavior regarding suspicious nail changes as well as satisfaction with nail counseling and examination. Results: Only 5% (18/363) of the patients in our study had heard of the ABCDEF mnemonic. In contrast, 9.9% (36/363) of the patients had heard of the ABCD mnemonic for cutaneous melanoma. In total, 37/363 (10.2%) patients reported having LM, 32.4% (12/37) of the patients noted changes in color or width of the band, and 10.8% (4/37) presented with pain or bleeding of the nail, with only 45.9% (17/37) seeking medical attention. Only 11.8% (43/363) of the patients stated that their physician asked them about nail changes, and 1.4% (5/363) of the patients stated that they were counseled about the ABCDEF mnemonic. In comparison, 13.8% (50/363) of the patients were advised on the ABCD mnemonic for the cutaneous melanoma mnemonic. While 70.2% (255/363) of the patients stated that they used sunscreen or wore sun-protective clothing, only 31.4% (114/363) assessed their nails for color changes, with 54.9% (128/233) of the patients categorizing themselves as “very unsatisfied” with the evaluation of their nails by their dermatologist. Conclusions and Relevance: Our data shows that there is a lack of patient knowledge of LM and warning signs for SM. Further testing is needed to determine whether educating patients about LM, warning signs for SM, and nail self-examinations would improve patient outcomes.

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Extent and consequences of physician delay in the diagnosis of acral melanoma

Cited by 117 publications

References 0 publications

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Misdiagnosed, Mistreated And Delay Diagnosed Acral Melanoma: The Atypical Presentations

Assessment of Patient Knowledge of Longitudinal Melanonychia: A Survey Study of Patients in Outpatient Clinics

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