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Case Reports
. 2016 Jul;95(29):e4332.
doi: 10.1097/MD.0000000000004332.

Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis

Wiebke Sondermann  1 , Lisa Zimmer, Dirk Schadendorf, Alexander Roesch, Joachim Klode, Joachim Dissemond
Affiliations
Case Reports

Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis

Wiebke Sondermann et al. Medicine (Baltimore). 2016 Jul.

Abstract

Acral melanoma has been reported to be associated with poorer outcomes than melanoma occurring on other cutaneous sites. It has been suggested that part of this disparity in outcomes may be related to delay in diagnosis. Therefore, we have analyzed the rate of misdiagnoses in patients with melanoma located on the foot and have characterized the influence on the clinical course and survival of the patients. A prospective, computerized melanoma database at the Skin Cancer Center of the University Hospital Essen, Germany was used to identify patients with histologically confirmed melanoma located on the foot between 2002 and July 2013 for subsequent analysis. A cohort of 151 patients diagnosed with primary melanoma located on the foot was identified. One hundred seven patients qualified for subsequent analysis. Forty-two patients were male (39.3%) and 65 (60.7%) were female; the mean age at first diagnosis was 61.6 years (median 66 years). The youngest patient was 19 years, the oldest 88 years old.Of the 107 patients analyzed, 32 (30%) were initially misdiagnosed. Misdiagnoses included chronic wounds, nevi, hematoma, fungal infections, warts, and paronychia. Misdiagnosis caused a median delay in diagnosis of 9 months. The 5-year disease-free survival rate (47.8% vs 72.7%) and the 5-year overall survival rate (63.5% vs 88.4%) were statistically significant lower in the misdiagnosis cohort.The awareness of potentially overlooked melanoma located on the foot has to increase among physicians.To improve early detection and, thus, the prognosis of patients with melanoma located on the foot, taking a biopsy from any suspicious lesion should be taken into consideration as soon as possible.

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Conflict of interest statement

WS has received honoraria from Roche and Novartis and travel support from Bristol-Myers Squibb, Novartis, and MSD. LZ served as consultant and received speaker's honoraria and meeting support from Roche, Bristol-Myers Squibb, MSD, Novartis, Merck, and GlaxoSmithKline. DS reports grant support and study fees to his institution from MSD and BMS; personal fees for serving as an advisory board, steering committee, and speaker's bureau member and for travel and hotel support from GlaxoSmithKline, Novartis, BMS, MSD, Merck-Serrono, Novartis, and Roche-Genentech; and personal fees for advisory board and speaker's bureau membership from Amgen and Boehringer Ingelheim. DS is the unpaid chairman of Dermatologic Cooperative Oncology Group (DeCOG) and is an unpaid member of guideline panel melanoma. AR received travel grants and honoraria from Roche, TEVA, GlaxoSmithKline, Bristol-Myers Squibb and travel and research grants from Novartis. JD and JK declare that they have no competing interests.

Figures

Figure 1
Figure 1
Calculated 5-year overall survival rate for the correctly diagnosed cohort versus the initially misdiagnosed cohort.
Figure 2
Figure 2
Melanoma located on the foot initially misdiagnosed as a fungal infection.
Figure 3
Figure 3
Flow chart for the diagnosis of melanoma located on the foot.
See this image and copyright information in PMC

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