Melanoma misdiagnosis brings ethical pitfalls
There are multiple ethical and legal considerations involved with the misdiagnosis of a melanoma, according to a recently published commentary.1
"It is sometimes very difficult to diagnose a melanoma," says Jane Grant-Kels, MD, one of the article's authors and chair and professor of the Department of Dermatology at the University of Connecticut Health Center in Farmington, CT.
Even an expert dermatologist can misdiagnose a melanoma as a benign lesion, and this is especially common in melanomas that are amelanotic or without pigment, adds Grant-Kels. "Once the lesion is biopsied and the correct diagnosis is made, the most important next step is to get the patient appropriately treated. The clinician should not cover up a misdiagnosis," she advises.
A misdiagnosis is not an error, as other experts also may have incorrectly diagnosed the lesion, says Grant-Kels, and this doesn't necessarily mean a malpractice case.
Even if the patient is litigious, that does not mean that they will find an expert to testify against a reasonable doctor who has examined the skin appropriately and missed a melanoma initially because it was a mimicker of a benign lesion, she says.
"The ethical next step is for the clinician to be truthful with the patient and arrange for them to be seen as soon as possible by a skilled surgeon for wide excision and possible sentinel lymph node biopsy," she says.
The major ethical concern with melanoma diagnosis is that some clinicians believe that they need to cover up their error, says Grant-Kels. "That is ethically wrong and will create legal issues. Do not tamper with your records," she says.
Instead, clinicians should add a detailed note to the chart as to why they initially did not recognize the lesion as a melanoma, and "immediately do whatever is needed to get the patient the best care moving forward," she advises.
Source
Jane Grant-Kels, MD, Chair and Professor, Department of Dermatology, University of Connecticut Health Center, Farmington. Phone: (860) 679-7692. E-mail: [email protected].
Reference
- Anderson J, Kels BD, Grant-Kels JM. Ethical considerations in alleged dermatologic malpractice. Clin Dermatol 2012;30(2):174-180.
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