Medicolegal aspects of neoplastic dermatology

Abstract

Medical malpractice litigation is rising at an explosive rate in the US and, to a lesser extent, in Canada. The impact of medical malpractice litigation on health care costs and the cost of insurance is dramatic. Certain specialist categories are becoming uninsurable in some parts of the US, while in others, clinicians are retiring early, restricting or changing practice or changing states of residence in consequence of medical malpractice claims and of the cost and availability of insurance. This, in turn, has had the real effect of denying care to patients in some communities in the US. Some 13% of all medical malpractice claims relate to one area of neoplastic dermatopathology, specifically, melanocytic neoplasia. Certain steps can be taken by pathology laboratories to reduce, but never completely eliminate, the risk of medical malpractice claims. In this review, attention is paid to the source of medical malpractice claims and an abbreviated approach to specific strategies for risk management is presented.

Morphological features of naevoid melanoma: results of a multicentre study of the International Dermoscopy Society

“…The entity called naevoid melanoma (NeM) refers to a rare, diagnostically deceptive variant of melanoma that can mimic a naevus both clinically and histopathologically . The normal‐appearing architectural structure and the bland cytological features can resemble those of a dermal naevus, leading to misdiagnosis, with eventual recognition of the true nature of the lesion after it has metastasized or recurred.…”

The Dermatology Office and Dermatopathology Laboratory

“…Medical-legal cases involving nonmelanocytic lesions usually concern incorrect margin assessment, infiltrative neoplasms (e.g., squamous cell carcinoma with neurotropism), atypical intraepithelial proliferations (e.g., clonal Bowen's disease, porocarcinoma in situ), and misclassification of basal cell carcinoma variant (Crowson, 2006). Therefore, if the pathology report does not indicate the variant of basal cell carcinoma, the dermatology office could call the dermatopathologist and ask for the variant to be specified, provided the specimen submitted was not a superficial shave or minute fragments of a curetting.…”

“…In 2004, Lydiatt analyzed 99 cases for allegations of negligence to diagnose skin cancer; the results showed that ''misdiagnosis'' and ''failure to diagnose'' accounted for 20% and 54% of the claims made, respectively. In a different study, issues surrounding melanoma were the second most common cause of malpractice litigation; the misdiagnosis of melanoma was found to account for 13% of all malpractice claims from 1995 to 2001 (Crowson, 2006). A close relationship between the dermatology office and the laboratory may enable a reduction of such claims.…”

Dermatological legal claims in Japan

“…As for the trend of dermatological litigation in other countries, malignant melanoma is the chief source of malpractice claims in the specialty in the USA 15 . The two main causes for melanoma malpractice awards are delay in diagnosis and mistaken diagnosis which most typically present as an error by the histopathologist 16 . On the other hand, Drummond et al.…”