Understanding malpractice risk and practicing risk management strategies results in better care and a less stressful environment of practice. Errors in diagnosis are most commonly related to melanoma and neoplasms of the skin. To offset the threat of malpractice litigation, malpractice data can be used to focus safety efforts on common diagnostic errors. Recognition of sources of error in the analysis of pigmented lesions by dermatopathologists, and the development of new immunohistochemical or genotypic techniques for the recognition and distinction of malignant disease from benign pigmented lesions, will also provide important improvements in care and diagnosis in the future.
The misdiagnosis of skin cancer is a substantial source of medical malpractice litigation.
Multiple lines of evidence converge to suggest that melanoma represents a substantial source of risk within dermatology and dermatopathology.
Before considering medicolegal issues involving the misdiagnosis of melanoma, it is both appropriate and necessary to outline important general tenets in malpractice law.
The misdiagnosis of skin cancer is a substantial source of medical malpractice litigation. A recent analysis of claims submitted to a single large national malpractice insurance carrier revealed that 8.6% of all claims against pathologists and 14.2% of claims against dermatologists involved the terms skin cancer and/or melanoma.
In a 2003 study, Troxel reported on 362 pathology-related claims submitted to The Doctor’s Company for the years 1995 to 2001; 46 (13%) involved the misdiagnosis of melanoma. Melanoma ranked second only to breast cancer as the greatest source of pathology-related malpractice claims. In 2 later articles, using the same claims database but for the years 1998 to 2003, Troxel identified 335 pathology-based malpractice claims. The missed diagnosis of melanoma was the single most common occurrence for litigation, accounting for 42 (13%) of 335 cases. Furthermore, a recent examination of data from the Physician’s Insurance Association of America found melanoma to be the most common cause of medical misadventure among dermatologists, many of whom interpret histologic specimens themselves.
Multiple lines of evidence converge to suggest that melanoma represents a substantial source of risk within dermatology and dermatopathology. The risk associated with melanoma is understandable because (1) melanocytic lesions are perhaps the most common neoplasm in humans; (2) melanoma is arguably one of the most lethal of all malignancies; (3) the distinction between benign and malignant melanocytic lesions is often vexing, even for the most skilled of dermatopathologists; and (4) melanoma is a disease that affects both the young and old, causing more years of lost life than any other malignancy except leukemia.
With the incidence of melanoma in the United States increasing annually at 4% to 6%, and the inherent medicolegal risks involved in the histologic interpretation of pigmented lesions, a review of relevant medicolegal principles, suggestions to optimize care, and strategies to mitigate risk is very useful.