Pitfalls in the Diagnosis of Malignant Melanoma

Troxel, David B.

doi:10.1097/00000478-200309000-00012

Cited by 108 publications

(24 citation statements)

References 21 publications

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“…The odds of melanoma misdiagnosis are higher for partial biopsies than excisional biopsies and may result in potential legal ramifications. 27, 28 In lesions where any doubt persists on either side, a repeat biopsy is strongly recommended.…”

Section: Diagnostic Considerationsmentioning

confidence: 99%

Desmoplastic melanoma: A review

Chen

Jaimes

Barker

et al. 2013

Journal of the American Academy of Dermatology

147

171

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Desmoplastic melanoma (DM) is a variant of spindle cell melanoma typically found on chronically sun-damaged skin of older individuals. Early diagnosis can be challenging because it is often amelanotic and has a predominantly dermal component. DM can be difficult to diagnose not only clinically but also histologically, and can be mistaken for a variety of benign and malignant non-melanocytic spindle cell tumors when viewed on prepared histopathology slides. Pathologists have observed that DMs can manifest significant variation with respect to the extent of intratumoral cellularity, fibrosis and/or perineural invasion. Furthermore, some tumors present with a pure desmoplastic invasive component (>90%) while other tumors display mixed features of desmoplastic and non-desmoplastic melanoma. This has lead to the separation of DM into two histologic subtypes, pure and mixed. With a focus on the distinction between pure and mixed DM, this review will detail what is currently known about the diagnostic features of DM, discuss risk and prognostic factors and examine the current literature on disease progression and management.

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Section: Diagnostic Considerationsmentioning

confidence: 99%

Desmoplastic melanoma: A review

Chen

Jaimes

Barker

et al. 2013

Journal of the American Academy of Dermatology

147

171

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“…[3] Based on polled dermatopathologists, false negative interpretive errors of melanoma or atypical lesions that should be treated as melanoma typically accounted for 90% of total interpretive errors[13] (therefore representing 2.1% of total melanoma interpretive errors cases). False positive diagnoses typically accounted for 10% (therefore representing 0.23% of total melanoma interpretive error cases).…”

Section: Resultsmentioning

confidence: 99%

“…Melanoma was used as the other example because this cancer has a notoriously high rate of false negative diagnoses. [13]…”

Section: Methodsmentioning

confidence: 99%

Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

Ahlers

Stratman³

et al. 2014

Journal of Pathology Informatics

125

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Background:Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care.Aim:As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS).Methods:Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers.Results:When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types.Conclusions:The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.

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“…One study reported that among claims submitted to a large national malpractice carrier, 8.6% were claims against pathologists and 14.2% were claims against dermatologists related to skin cancer and/or melanoma (2). Two additional studies found that a false negative diagnosis of melanoma was the most common cause of a malpractice pathology-related claim, representing 13% of 335 pathology-related claims (3, 4).…”

Section: Introductionmentioning

confidence: 99%

How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

Carney

Frederick

Reisch

et al. 2016

Journal of the American Academy of Dermatology

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Objective To identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices. Methods We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in ten states. The survey assessed dermatopathologists’ demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits. Results Thirty-three percent of dermatopathologists reported past malpractice experiences. Factors associated with being sued included older age (57 years vs. 48, p<0.001), lack of board certification or fellowship training in dermatopathology (76.5% vs. 53.2%, p=0.001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs. 20.1%, p<0.001). Sixty four percent of participants reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions. Conclusions Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.

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Pitfalls in the Diagnosis of Malignant Melanoma

Cited by 108 publications

References 21 publications

Desmoplastic melanoma: A review

Desmoplastic melanoma: A review

Can Digital Pathology Result In Cost Savings? A Financial Projection For Digital Pathology Implementation At A Large Integrated Health Care Organization

How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

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