Pitfalls in the diagnosis of malignant melanoma: findings of a risk management panel study

The misdiagnosis of melanoma is a major cause of malpractice claims involving pathologists and dermatologists. A detailed analysis of individual surgical pathology and cytology claims (excluding Pap smears) reported to The Doctors Company from 1995 through 2001 revealed that 46 of 362 claims (13%) involved the misdiagnosis of melanoma; 70% of these claims were for false-negative diagnoses. Melanoma claims were second only to claims involving breast biopsy. A Melanoma Risk Management Panel of expert dermatopathologists was convened to discuss recurrent "problem areas" identified by the author in claims reviewed from 1998 through 2001. The purpose was to devise useful strategies that pathologists and dermatologists could use in their practices to reduce the risk of diagnostic error and/or patient mismanagement when dealing with melanocytic lesions. The panel's findings and recommendations are the subject of this review.