Under the microscope: doctors, lawyers, and melanocytic neoplasms

Abstract

Misdiagnosed melanoma remains one of the most common causes of lawsuits in histopathology. Reasons for this are discussed in conjunction with relevant literature, common errors in diagnosis, and strategies to avoid them.

Medicolegal aspects of neoplastic dermatology

“…23 The fourth consideration is that melanoma, as it is a disease of young as well as old patients, has the potential to cause great loss of life with attendant social and economic disruption for the family members of the deceased, as it results in more lost years of life per case fatality than any other neoplastic disorder, except perhaps leukemia. 1,24 Underdiagnosis With respect to the underdiagnosis of melanoma, several factors can increase the risk of such events. First of all, as mentioned above, partial samples of melanocytic tumors may fail to represent the most aggressive morphology in any given lesion.…”

“…With respect to specimen embedding and paraffin blocks, the pieces of tissue must be close enough together to facilitate good sectioning and also to help ensure that the pathologist does not fail to examine a tissue element. 1 Secondly, if too many tissues elements are incorporated into the tissue cassette prior to paraffin embedding, orientation of the tissue elements by the histotechnologist is compromised, and microscopic interpretation becomes more difficult. Similarly, the orientation of the tissue elements to the block face by an experienced histotechnologist will help to avoid tangential sections, which may compromise interpretation and also make accurate Breslow thickness measurements difficult or impossible.…”

“…Some malpractice insurers are no longer covering physicians, 1 and the issue of uninsured physicians leaving medical practice has impacted a broad array of specialties and become a major political issue at the state and national levels. Dermatology and dermatopathology are impacted by this trend.…”

“…1,5,8,9 The concept of duty relates to the responsibility of a physician to a patient and flows from the relationship between the patient and their physician. A pathologist who picks up a slide for interpretation and then issues a report at once establishes the relationship between himself and the patient.…”

“…1,11,12 Tort reform, when the result of effective and welldesigned legislation, has a tendency to reduce malpractice damage awards and consequently to reduce the cost of medical malpractice insurance. In particular, those states that have imposed hard caps on noneconomic damages (ie pain and suffering of patients and their families) experience a reduction in insurance premiums and also in the number of medical malpractice claims.…”