Analysis of 118 cases of clinically misdiagnosed cutaneous melanoma / 中华皮肤科杂志

ABSTRACT

Objective:To investigate clinical features and preventive measures of misdiagnosed cutaneous melanoma, as well as causes of its misdiagnosis.Methods:Clinical data were collected from patients with pathologically confirmed cutaneous melanoma which was initially clinically misdiagnosed as other diseases in Department of Dermatology, Xijing Hospital, the Fourth Military Medical University from January 2005 to December 2019, and clinical manifestations and causes of its misdiagnosis were analyzed.Results:A total of 118 patients with clinically misdiagnosed cutaneous melanoma were collected, including 38 males and 80 females. The median age at misdiagnosis was 48 years, the median age at onset was 40.5 years, and the median disease duration was 54 months. The main skin lesions were black maculae and papules. The initial clinical diagnoses were pigmented nevi (53 cases, 44.92%) , nail matrix nevi (12 cases, 10.17%) , seborrheic keratosis (14 cases, 11.86%) , vascular tumors (10 cases, 8.47%) , squamous cell carcinoma (5 cases, 4.24%) , basal cell carcinoma (4 cases, 3.39%) and other diseases (20 cases, 16.95%) . As far as the ABCDE (asymmetry, border irregularity, color variegation, diameter > 6 mm, evolving) rule for melanoma was concerned, 78 (66.10%) , 64 (54.24%) , 57 (48.31%) , 66 (55.93%) and 39 (33.05%) cases conformed to hte A, B, C, D and E rules respectively, 14 conformed to the ABCDE rule, 13 conformed to the ABCD rule, and 13 did not conform to any of them. Among the 53 cases of melanoma in situ, 28 (52.83%) were misdiagnosed as pigmented nevi, 11 (20.75%) as nail matrix nevi; among the 66 cases of invasive melanoma, 25 (37.88%) were misdiagnosed as pigmented nevi, 9 (13.64%) as vascular tumors, and 5 (7.58%) as squamous cell carcinoma. The information of physicians of 67 misdiagnosed patients was available, and those of 42 out of the 67 patients had clincial experience of ≤ 5 years; among 27 misdiagnosed patients conforming to the ABCD or ABCDE rule, the information of physicians of 9 patients was available, and those of 7 out of the 9 patients had clinical experience of ≤ 5 years. Conclusion:Cutaneous melanoma has a variety of lesion patterns and is easily misdiagnosed, and physicians′ clinical experience and the ABCDE rule-based evaluation are important for diagnosis.