Skin cancer is by far the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. The third form, melanoma, is much less common, accounting for less than 2 percent of all skin cancer cases. However, given its tendency to spread, melanoma is a far more serious form of skin cancer, and, if not detected and treated in its earliest stages, can be deadly.
In a typical year, there will be approximately 76,000 new melanoma cases in the U.S. and 9,700 deaths caused by the disease, according to the American Cancer Society. The rate of new melanoma cases is expected to increase in coming years consistent with increasing rates over the past 30 years.
What is skin cancer?
The skin is the largest organ of the human body and serves a number of important functions, including protecting internal organs from injury, blocking out germs, controlling body temperature, and preventing the loss of too much water and other fluids. It is comprised of three layers: epidermis, dermis and subcutis. The outermost layer is the epidermis, which contains a variety of cell types, including melanocyte cells that produce a brown pigment called melanin. This gives the skin a tan or brownish color when exposed to the sun.
Tumors that start in melanocytes include moles (almost all of which are benign), lipomas (soft growths made up of fat cells), hemangiomas (blood vessel growths often called cherry or strawberry spots), and warts. Melanoma skin cancers are usually brown or black tumors, but they can also appear pink, tan or white. Melanoma can occur anywhere on the skin, although the most common area for men is the chest or back, and the most common area for women is on their legs. Melanomas are more serious than basal cell or squamous cell cancers because they are much more likely to spread to other parts of the body if not caught early.
Exposure to ultraviolet (UV) rays from the sun, tanning beds and tanning lamps can damage skin cells. Skin cancers begin when this damage affects the DNA of genes that control how and when skin cells grow and divide. Melanoma cancer on the back, chest or legs is linked to frequent sunburns (especially in childhood). Individuals with fair skin, a large amount of freckles, and light hair have a greater risk of getting melanoma cancer. Other risk factors include having a large amount of moles, a prior history of having melanoma cancer, a family history of melanoma, or immune suppression caused by medicines to treat an organ transplant.
How is melanoma diagnosed?
Potential symptoms of melanoma are unusual sores, bumps, blemishes, markings or other changes to the appearance of an area of skin. A doctor should examine any suspicious areas or unusual moles, as well as conduct a thorough physical exam, including taking an individual’s personal medical history. The doctor may also examine lymph nodes in the neck, underarm or groin (when melanoma cancer spreads if often first goes to nearby lymph nodes). The doctor may also perform a biopsy to remove a skin sample for microscopic examination by a pathologist. A dermatologist (skin specialist) can use a dermatoscope to closely examine the suspicious skin lesion.
The most important warning sign for melanoma cancer is a new spot on the skin or a spot that is changing in size, shape or color. Another important warning sign is a spot that looks different from all other spots on the skin.
The ABCDE rule is a guide to the usual signs of melanoma:
- A is Asymmetry: One half of a skin lesion, mole or birthmark does not match the other.
- B is Border: The edges of a lesion are irregular, ragged, notched, or blurred.
- C is Color: The color of the lesion is not the same all over and may include shades of brown or black, or sometimes have patches of pink, red, white or blue.
- D is Diameter: The skin spot is larger than 6 millimeters across (about ¼ inch).
- E is Evolving: The skin lesion is changing in size, shape or color.
Other warning signs are sores that do not heal, redness beyond the border of a new swelling, a change in the sensation of the lesion (itchiness, tenderness or pain), or a change in the surface of a mole.
Missed or delayed diagnosis of melanoma
Physicians can miss diagnosing melanoma for a number of reasons. Biopsy sampling errors are a primary cause of delayed diagnoses. For example, a doctor should remove an entire lesion suspicious of melanoma to allow a pathologist the best chance of making a definitive diagnosis. About ½ of melanomas arise from previously benign lesions. If a doctor takes a partial sample, that portion could be benign. Or a partial sample may be symmetrical, when in fact the entire lesion is asymmetrical (a telltale sign of melanoma).
Other reasons for delayed diagnosis of melanoma are:
- A physician’s failure to perform a biopsy of a suspicious lesion, or failure to refer a patient to a specialist when a lesion is suspicious of melanoma
- A physician downplaying or failing to recognize the significance of presenting symptoms, especially changing sizes, shapes and coloration of lesions
- A physician failing to review a pathology report indicating presence of melanoma
- A dermatologist mistaking a lesion as benign when it mimics other benign skin conditions, or when it does not exhibit typical characteristics of melanoma
- A pathologist misinterpreting a biopsy sample, or failing to conduct a thorough microscopic examination of a sample
- A pathology lab mishandling a biopsy sample
Consequences of missed or delayed diagnoses of melanoma
A missed or delayed diagnosis of melanoma often directly impacts a patient’s chance of survival. The danger of melanoma is that, unlike basal cell or squamous cell skin cancer, it has a tendency to spread to other parts of the body if not detected and removed early. If the lesion is completely removed in Stage I of the cancer the five-year survival rate is about 95 percent, and about 80 percent in Stage II. The prognosis drops considerably for later stages of the disease (about 40 percent for late Stage III and about 20 percent for Stage IV).
Early stage melanoma can be treated effectively with surgery alone. A wide excision can cure early stage melanoma by removing the tumor along with a small amount of non-cancerous skin at the edges. Chemotherapy is usually not as effective in treating melanoma cancer as it is for other types of cancer, but it may relieve symptoms or extend survival of later stage patients. Immunotherapy can shrink advanced stage melanoma cancer, and is sometimes combined with chemotherapy treatments. About half of all melanomas involve mutations in the BRAF gene, which cause rapid cell growth and division. Targeted therapy for melanoma involves treatments to attack genetic changes.
Did a delayed diagnosis of melanoma increase my chance of death?
Based on its experience in handling delayed diagnosis cases, the attorneys at Powers & Santola, LLP, build clear, compelling cases for recovery. Melanoma cancer patients who would have had a near certain prognosis of cure and survival with an early diagnosis can recover for an “increased chance of death” or harsher treatment regimens they have to endure as a result of a delayed diagnosis of their cancer.
Powers & Santola, LLP, attorneys are dedicated to providing outstanding legal representation to individuals who have been harmed by a needlessly delayed diagnosis of melanoma. Knowledge and talent is a part of legal excellence, but it also entails having the resources and a commitment to fundamentally changing the lives of our clients and their families for the better. We do this by helping them find answers to difficult questions, and to obtain full and fair compensation for the harm caused by medical malpractice.
Founded in 1987, Powers & Santola, LLP, has established a reputation for outstanding legal representation of injured clients by devoting its full attention and resources to a limited number of very seriously injured clients in New York and other states.When we agree to represent someone, we resolve that our services will be dedicated to helping that person improve his or her life for the better. To make that commitment meaningful, we focus our skills, efforts and other resources on helping a select group of clients.
We are here to help you find the answers you need. To talk with us about a lawsuit involving a delayed diagnosis of melanoma cancer, call Powers & Santola, LLP, toll free at 518-465-5995 or contact us online.