Failure to Diagnose & Delay in Treatment of Melanoma

Evaluate breaches in the standard of care when determining a Failure to Diagnose & Delay in Treatment of Melanoma

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present with? (Choose all that apply)
    A change in existing mole, development of a new pigmented or unusual looking growth, spreading of pigment into existing skin, oozing/bleeding from an existing mole
    Vision changes, abnormalities found during a routine eye examination
    Nasal bleeding, a mass in the nose or nasal obstruction
    Urinary bleeding, discharge, itching, feeling of a mass, urinary disturbance, abdominal swelling, and pain
    Anal bleeding, painful defecation, lesion around the anus
    Dysphagia (difficulty in swallowing), weight loss, pain
    Symptoms not elicited
    Answer unknown
    Why is this important?
    Early clinical recognition of melanoma is essential in the successful treatment of this cancer.
    (2012) 30 EDERMC 1 113-124

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Identification of people at high risk for melanoma introduces the possibility of reducing incidence and mortality through primary and secondary prevention.
    Click here for additional information at ClinicalKey.com

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions that must be addressed at various points throughout the patient's lifetime. Early clinical recognition of melanoma is essential in the successful treatment of this cancer. When melanoma is suspected, a whole body examination serves as a tool to assess the existing lesion and also identify other lesions that could possibly arise.
    (2012) 30 EDERMC 1 113-124

  • Was the patient discharged from the facility with a different diagnosis and later diagnosed with melanoma? Why is this important?
    Answer this question
    In patients over the age of 40 years, if a new pigmented lesion develops, melanoma should be suspected.
    (1998) 82 EMEDCN 6 1325-1358

  • To which specialist was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    All patients with suspicious lesions should be referred to a dermatologist for excisional biopsy and diagnostic testing.
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  • Was an excisional biopsy performed? Why is this important?
    Answer this question
    Skin biopsy remains the standard of practice for diagnosing cutaneous melanoma. Excisional, incisional, shave, and punch biopsies are common techniques.
    (2012) 30 EDERMC 1 113-124

  • Did the patient’s biopsy report confirm the presence of a malignant melanoma? Why is this important?
    Answer this question
    The ultimate diagnosis of a melanoma depends on the biopsy pathology.
    (1998) 82 EMEDCN 6 1325-1358

  • Which of the following details did the histopathology report contain? (Choose all that apply) Why is this important?
    Answer this question
    Pathologic examination of the biopsy sample by a pathologist or dermatopathologist experienced in the diagnosis and treatment of melanoma is essential.
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  • Was staging of the melanoma performed? Why is this important?
    Answer this question
    The current American Joint Committee on Cancer staging system includes the thickness and presence or absence of ulceration of the primary tumor, the number of positive nodes, whether the nodes are microscopically or macroscopically positive, and whether distant disease is present.
    Click here for additional information at ClinicalKey.com

  • Were other melanocyte proliferation disorders ruled out? Why is this important?
    Answer this question
    Some melanocytic proliferation can be diagnostically challenging. These include: atypical melanocytic proliferation (AMP), superficial melanocytic tumor of uncertain significance (SAMPUS), atypical Spitz tumor and atypical cellular blue nevus.
    Click here for additional information at ClinicalKey.com

  • What was the stage of melanoma at presentation? Why is this important?
    Answer this question
    Patients with melanoma can be clinically staged after histopathologic micro-staging of the primary tumor.
    Click here for additional information at ClinicalKey.com

  • Was a sentinel lymph node biopsy performed for stage I and II melanoma? Why is this important?
    Answer this question
    Sentinel lymph node mapping is a useful staging procedure for melanoma and provides prognostic information.
    Click here for additional information at ClinicalKey.com

  • Did the patient present with any risk factors indicative of melanoma of the eyes? Why is this important?
    Answer this question
    Ocular melanoma is the most frequent extra-cutaneous melanoma, accounting for 80% of these tumors. Moreover, ocular melanoma is the most common primary tumor of the eye in the adult.
    (2011) 6 EPETCL 1 79-89

  • Was the patient referred to an ophthalmologist? Why is this important?
    Answer this question
    In general, ocular melanoma is asymptomatic, and can be revealedonlyby a routine eye examination.
    (2011) 6 EPETCL 1 79-89

  • Was an ultrasound of the patient’s eye performed? Why is this important?
    Answer this question
    After intraocular examination by ophthalmoscopy, eye ultrasonography (US) is mandatory to confirm and characterize the suspected lesion.
    (2011) 6 EPETCL 1 79-89

  • Was the size of the patient’s eye tumor determined? Why is this important?
    Answer this question
    Treatment for eye melanoma is dependent upon the size of the lesion. Lesions are characterized based upon their size.
    (2011) 6 EPETCL 1 79-89

  • Which of the following diagnostic studies were performed to rule out metastases? (Choose all that apply) Why is this important?
    Answer this question
    In cases of metastatic disease the prognosis is very poor, similar to that for advanced cutaneous melanoma. The only treatment with palliative intent is chemotherapeutic drugs and interferon.
    (2011) 6 EPETCL 1 79-89

  • Was a fine needle aspiration or an open biopsy performed to confirm the suspected metastatic lesion? Why is this important?
    Answer this question
    For patients presents with stage IV disease, the suspected metastatic disease needs to be confirmed with either Fine Needle Aspiration (FNA) or with an open biopsy of the lesion.
    Click here for additional information at ClinicalKey.com