MALIGNANT MELANOMA

Most forms of skin cancer only invade locally and, though capable of damaging vital structures in or adjacent to the skin, do not spread to distant organs. Malignant Melanoma is the major exception, and potentially is highly lethal. It is common knowledge that the incidence of this tumour has increased dramatically over the past few decades.

PRACTICE POINT Both surgeon and pathologist are responsible for the adequacy of a biopsy in suspected melanoma

There has been a similar increase in successful medical malpractice litigation. The usual issues are failure to biopsy atypical moles, adequacy of the biopsy, and incorrect interpretation by the pathologist. Biopsy is usually not technically difficult, but minimum of 5 mm in diameter and depth into the skin is required to obtain a representative sample in the majority of cases[1]. While the surgeon has the responsibility to observe such guidelines, the pathologist has a similar obligation to report smaller biopsies as inadequate for assessment.

PRACTICE POINT Insufficiently experienced pathologists may miss, or fail to refer, suspicious features in atypical melanoma

Typical pathological finding are easy to identify, but specialists with insufficient experience may miss suspicious features which are readily recognised by melanoma experts.

In early (Stage I) tumours, the Clark method of estimating prognosis is unusually reliable and continues to be validated[2].

PRACTICE POINT For early melanomas, evidence-based causation is not usually in dispute

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