Claims for delay in diagnosis of cancer are common in Ohio. Medical malpractice cases involving a delayed diagnosis, or a delay in treatment, of malignant melanoma require consideration of a number of factors. A recent medical study underscores the importance of proper surgical treatment upon timely diagnosis of this potentially deadly cancer.
Malignant melanoma is a type of skin cancer. One in 87 Americans will develop this cancer is their lifetime. The incidence and mortality rate associated with malignant melanoma are both rising. Risk factors for the disease include age, complexion, sun exposure, tanning booth exposure, family history and immunocompromise.
When caught early and treated properly, the prognosis for malignant melanoma is excellent. However, delays in diagnosis can lead to progression of the disease from an early, treatable stage to an advanced, incurable stage. As with most other cancers, early detection saves lives, while a delay in diagnosis of cancer can cost lives. Delays in diagnosis and treatment may occur for a number of reasons that are attributable to medical negligence: (1) failure to screen or failure to refer to a dermatologist for screening; (2) failure to remove and send pigmented lesions (e.g, moles) for evaluation by a properly trained pathologist; or (3) misinterpretation of pathology slides.
In addition, medical negligence may arise by a failure to properly treat malignant melanoma once detected by a pathologist. The primary treatment found to be effective in preventing the spread of malignant melanoma is surgical removal. Unlike other cancers, malignant melanoma is not amenable to chemotherapy or radiation therapy. Several experimental treatments are available, including intereferon therapy, but none has been shown to be curative.
In order for surgical excision to be effective, the surgeon must obtain “clean margins.” This means that the tumor is completely removed and the pathologist finds that there is no tumor that connects to the skin left behind after surgery. Absent clean margins, the tumor may grow back (called a “local recurrence”) and spread to other parts of the body through the lymphatic system and bloodstream, including to lymph nodes, the liver and the brain.
In order to obtain clear margins, certain standards of care have developed to assure a surgeon that an adequate periphery of noncancerous tissue has been established around the tumor site. A recent study published in the Journal of the American Academy of Dermatology showed that, to clear melanomas, 6-mm margins were sufficient in 86% of cases, 9-mm margins cleared 98.9%, 1.2 cm cleared 99.4%, 1.5 cm cleared 99.6%, and 100% of lesions were cleared with 3-cm margins.
