The most common challenges in melanoma diagnosis and how to avoid them

Abstract

Due to its particularly lethal nature and tendency to affect relatively young individuals, the timely diagnosis of melanoma remains of paramount importance for clinicians and their patients. Unfortunately, melanomas can mimic benign lesions that are overwhelmingly more common in the population than are melanomas, and misdiagnosis or delay in diagnosis of melanoma can occur. Misdiagnosis of melanoma serves as one of the most common causes for malpractice litigation brought against medical practitioners. In this review we describe seven clinical scenarios that represent challenges in melanoma diagnosis and discuss potential strategies for avoiding the errors that commonly give rise to those scenarios.

How to diagnose nonpigmented skin tumors: A review of vascular structures seen with dermoscopy

“…In such cases, polychromatism (shades of pink, white, red, blue, brown, or gray) may be the only clue for the correct diagnosis (Fig 10). 17,26,[35][36][37][38][39] Eczema-like melanoma is a rare variant of melanoma (to our knowledge, only six cases have been published to date) that can be extremely difficult to diagnose because of its similarity to a range of inflammatory or infective processes, including nummular eczema, psoriasis, verrucous lichen planus, and tinea corporis. The clinical presentation is remarkable in that it typically presents as a solitary, scaly patch or plaque typically located on the extremities and is resistant to various topical treatments.…”

Melanocytic nevi with special features: clinical‐dermoscopic and reflectance confocal microscopic‐findings

“…Regarding the time of occurrence, a quick recurrence of the pigmentation (up to 6 months after excision) favours a diagnosis of a benign recurrent nevus, whereas melanomas usually recur slowly, several months to years after excision. Benign recurrences are confined to the scar, arising in the centre of the scar and extending within the scar . Melanomas tend to recur beyond the bounds of the scar onto the normal skin .…”

Integrating clinical/dermatoscopic findings and fluorescence in situ hybridization in diagnosing melanocytic neoplasms with less than definitive histopathologic features

“…However, it is well recognized that there are a number of diagnostic scenarios that frequently pose a dilemma. 2,8,12,14,15 Among these challenging scenarios are dysplastic nevi versus early melanoma and Spitz nevus versus Spitzoid melanoma. 16,17 The importance of preoperative dermatoscopic evaluation and digital dermatoscopy and/or photography follow-up is underscored.…”

“…Upon institutional review board approval, we searched electronic patient databases for cases between January 2008 and February 2010 that met the following criteria: (1) FISH evaluation was positive for melanoma; (2) histopathology was considered to be ambiguous by the dermatopathologist; and (3) cases were considered highly suspicious for melanoma by clinical and/or dermatoscopic parameters by the dermatologist.…”

“…1 Early diagnosis of melanoma remains of paramount importance for clinicians and their patients, 2,3 because it is widely accepted that survival is strongly related to melanoma size and depth in tissue. Thus an early definitive diagnosis is essential to successful management of the disease.…”