Diagnóstico clínico del melanoma cutáneo primario en el Área de Salud II de la comunidad autónoma de la región de Murcia

Abstract

Abstract—Introduction. The average percentage of false negatives in the clinical diagnosis of melanoma is between 20% and 50 %. The objective of this work is to assess and compare the accuracy of the clinical diagnosis in the Dermatology Department and other non-dermatology departments that have participated in the diagnosis and treatment of melanoma, compare it with the experience of other authors on this subject and evaluate and compare the delay between the clinical diagnosis and the surgical excision of the melanoma between these two groups. Material and methods. The reports from the files of the Pathology Department of Hospital Santa María del Rosell requesting an anatomopathological study whose histopathological diagnosis was primary cutaneous melanoma were retrospectively studied for the years 2000, 2001 and 2002. The clinical data, departments involved in the diagnosis and treatment, clinical diagnosis and histopathological findings (type of melanoma and Breslow index) were evaluated. The delay in days from clinical diagnosis to surgery for the lesions was obtained from the database of the hospital’s appointment center, and from the different Health Facilities. Results. 52 cases were reviewed, accounting for 1.2 % of all patients with skin lesion biopsies in those three years. The departments involved in the clinical diagnosis and treatment of the melanomas were: Dermatology (n = 24), General Surgery (n = 22), Primary Care (n = 3), Plastic Surgery (n = 2) and the Urology Department (n = 1). Melanoma was clinically diagnosed in 18 cases, all studied by the Dermatology Department (75 % sensitivity). The most frequent type of melanoma was the superficial spreading type (n = 38). Most of the lesions had a low Breslow thickness («in situ» and less than 1 mm = 30 cases, or 57.6 %). The comparison of the averages of the Breslow indices in the two groups is similar. The average delay in the Dermatology Department was 36.3 days ± 19.47, and in the non-dermatology departments, 100 days ± 61.51; the statistical analysis of this data shows that the differences are significant (p < 0.003). Conclusion. The Dermatology Department was the only one that made a correct clinical diagnosis of the cutaneous melanoma with an average delay of 36 days between diagnosis and surgery. The other departments did not make a clinical diagnosis of melanoma in any case, so these patients were on the surgical waiting list for months with an erroneous clinical diagnosis of benignancy, which caused a considerable delay in the surgical treatment.