Melanoma or Not - Case 1

"A patient presents with a moderate-risk melanoma diagnosed elsewhere for further surgery. The original slides were reinterpreted as an unusual nevus or mole which was not malignant and thus the patient needed no further surgery".

One would think this could not happen, but in fact this is a common occurrence. Pathologists and Dermatopathologists would much rather error on the side of over interpretation to avoid missing a serious malignancy such as melanoma, which can lead to metastasis, or spread of the cancer, and death. One would think the interpretation of funny or atypical moles and melanoma would be clear-cut, but this is in fact not the case. Studies have shown that an unusual mole, such as the one this patient had, can be sent to ten different preeminent Dermatopathologists around the country and there would be no consensus. Some of them might call it malignant requiring aggressive surgery, others might call it atypical or unusual requiring complete removal, and even others might call it completely benign or non-cancerous needing no further treatment. This degree of uncertainty and lack of consensus in our field is unacceptable, and again, leads to unnecessary surgery for patients around the country. If you have been diagnosed with a melanoma most of the time that diagnosis will be accurate. There are occasional cases where there has been over- interpretation of a mole as melanoma, which might require just a simple re-excision or no treatment at all as opposed to the aggressive surgery that is needed to treat a true melanoma. Any diagnosis of melanoma deserves a second look or second opinion.

Melanoma or Not - Case 2

"A patient presents for surgery with a previously diagnosed squamous cell carcinoma of the cheek. The original biopsy was reviewed and in fact showed melanoma not squamous cell carcinoma dramatically changing the treatment plan resulting in additional surgery and sentinel lymph node biopsy to give her the best care possible".

One would again think that this mistake could not happen, but in fact it is not unusual when patients have a melanoma that has no pigment in it; so-called amelanotic melanoma. These are pink bumps or scaly red patches, not the typical irregular black changing mole we think of as melanoma (figure I). These sorts of cases could be mistaken both by the clinician and by the unwary pathologist as basal or squamous cell carcinoma resulting in much less aggressive treatment than is actually necessary to cure these patients. These sorts of mistakes can possibly lead to much greater harm to the patient. An undiagnosed, untreated, or inadequately treated melanoma can eventually lead to spread of the disease and the death.