Skin cancer is the most common form of cancer in the United States. Thankfully, most skin cancer relatively harmless. But, in a minority of cases, skin cancer can be lethal. In too many cases, the difference between minor and lethal is the misdiagnosis of a doctor, usually a patient's primary care doctor, who steps over signs and symptoms of skin cancer. If you or a family member had skin cancer that you believe was misdiagnosed, call 800-553-6000 or get a free online consultation for your potential malpractice claims.

The most common types of skin cancer include melanoma, basal cell skin cancer and squamous cell skin cancer.  There are also other more rare forms of skin cancer such as Merkel cell carcinoma.  Approximately, 68,000 Americans are diagnosed with melanoma each year, positioning itself as the sixth most common form of cancer in the US.  An additional 48,000 Americans are diagnosed with a form which involves only the outer most layer of the skin each year.

Further, 2 million people are treated for basal cell or squamous cell skin cancer annually. Malignant melanoma is an aggressive and often fatal form of skin cancer.  It is also the second most misdiagnosed form of cancer. Melanoma represents only 4% of all skin cancers, but accounts for 73% of all skin cancer deaths. It is estimated that approximately 8800 deaths will occur in 2011 (65% of these will be men).  Early stage diagnosis and treatment provides the best chance for cure.

In 2011, it is estimated that approximately 70,000 Americans (40,000 men and 30,000 women) will develop cutaneous melanoma and nearly 47,000 will develop melanoma in situ.  It is important to note that incidence may be higher due to under reporting.  The risk of developing melanoma is 1 case per 57 Americans and increases to 1 case per 33 if non-invasive melanoma in situ is included.  Incidence has continued to rise throughout the world especially in Australia and New Zealand.  Further, prevalence is higher in white Caucasians than African Americans and Hispanics, however, mortality rates are higher in African Americans and Hispanics.  It is also noteworthy that invasive melanoma is more prevalent in women than men in people under 40 years of age, but more prevalent in men 40 years of age and older. 

Visual inspection is often used to distinguish melanoma with other skin pigmentation changes. Experienced visual inspection is often the key to distinguishing a melanoma from other pigmentation changes.  An ABCDE system was developed by the American Cancer Society to serve as a guideline for early melanoma warning signs as follows:

A = Asymmetry (opposite segments are different)
B = Border (border of melanoma is usually irregular
C = Color (variation in color)
D = Diameter (diameter greater than 6mm, but it is also possible to diagnose smaller melanomas)
E = Elevation (though easier to diagnose elevated melanomas, outcomes are better when diagnosed flat)

Skin cancer shares symptoms with some other diseases which can lead to misdiagnosis. For doctors who are lax and do not believe in ruling out all of those less serious diseases, a skin cancer misdiagnosis can have grave consequences. Skin cancer is the second most misdiagnosed cancer, behind breast cancer.  It is imperative that further tests be performed to confirm diagnosis of skin cancer or second opinions are sought.  For example, bumps or lumps under the skin may be misdiagnosed as pimples, warts, cysts or lipoma (flat tumor) and changes in the skin's condition such as a sore or growth may be misdiagnosed as a skin infection or another non-cancerous symptom. 

Similarly, misdiagnosis of basal cell carcinoma occurs. In a recent review of literature, it was reported that vulvular basal cell carcinoma is often misdiagnosed as appearance mimics eczema or psoriasis.  The main symptom is itching which often gets dismissed as an irritation and leads to inappropriate treatment.  This article highlighted the need to recognize that both melanoma and basal cell carcinomas occur in areas that are not typically exposed to UV radiation (ie., lower body including genitals and feet), which further complicates measurement of risk and diagnosis. 

Misdiagnosis may include improper evaluation of symptoms or incorrect interpretation of biopsy histopathology reports or the misdiagnosis of skin cancer as other diseases or inflammatory responses which lead to delays in identification.  With early diagnosis being one of the most important factors in a positive outcome, a delay in proper identification can be fatal.  Misdiagnosis may also include a symptom or change in the skin which is diagnosed as cancer in haste.  In such cases patients undergo surgeries to remove these 'so-called' carcinomas when in fact it was not necessary. Further, metastasis of melanoma to other organs is often misdiagnosed.  For example, it is plausible for melanoma to metastasize to the stomach, but when masses are identified in the stomach the diagnosis is usually primary gastric carcinoma.  In a recent published case study, both macroscopic and microscopic misdiagnosis were identified.   Most melanoma deaths involve metastasis to other organs.  Misdiagnosis of metastasis can lead to inappropriate treatment which can in turn increase the potential for negative outcomes.  These situations of misdiagnosis lead to increased burden on the health care system, loss of wages, unnecessary surgeries and undue mental and emotional anguish.

In a published review article on studies related to malpractice claims, many studies pointed to physician training and experience as a cause of misdiagnosis.  This review article also reported that the most common malpractice claims against pathologists were due to false-negative diagnosis of melanoma.  The authors did not find any cases of misdiagnosis due to laboratory error, follow-up or patient-related delays.  The article also cites a study conducted in Sweden, which estimated the rate of misdiagnosis to be 15% among dermatologists.  The lowest incidence of misdiagnosis occurred with dermatologists with greater than 10 years experience and exposure to more than 10 melanomas annually and accuracy in diagnosis increasing with experience. The study also found that physicians with less than 1 year of dermatologic experience were able to diagnose 31% of patients compared to 63% for physicians with more than 10 years experience.