title: Learning from mistakes: errors in approaches to melanoma and the urgent need for updated national guidelines.
abstract: BACKGROUND
  The tracking and identification of errors in the detection and follow-up of melanoma are important because there is huge potential to increase awareness about the most vulnerable aspects of diagnosis and treatment, and to improve both from the perspective of healthcare economics. The present study was designed to identify where errors occur and to propose a minimum set of rules for the routine guidance of any specialist in melanoma management.
  
  
  METHODS
  This report describes the evaluation of a unique series of 33 cases in which errors applying to many steps in the diagnosis and treatment of melanoma were detected. Cases were collected at two centers in Romania, one public and one private, as part of a process of obtaining patient-requested second opinions.
  
  
  RESULTS
  A total of 166 errors were identified across the 33 patients, most of which were treatment errors. The errors fell into six categories: clinical diagnostic errors (36 errors among 30 patients); primary surgical errors (31 errors among 16 patients); pathology errors (24 errors among 17 patients); sentinel lymph node biopsy errors (13 errors among 13 patients); staging errors (17 errors among 13 patients); and treatment or management errors (45 errors among 33 patients).
  
  
  CONCLUSIONS
  Based on the present results, we propose that in countries lacking national guidelines, clinicians should adhere to international evidence-based guidelines for the diagnosis and treatment of melanoma.
authors.affiliation: Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Olga
authors.initials: O
authors.lastname: Simionescu
authors.affiliation: Dermatology, Public, Private and Teaching Practice, Konstanz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Blum
authors.affiliation: Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Grigore
authors.affiliation: Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Mariana
authors.initials: M
authors.lastname: Costache
authors.affiliation: Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Alina
authors.initials: A
authors.lastname: Avram
authors.affiliation: Dermato-Oncological Division, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Testori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D062109:Dermatologic Surgical Procedures / Q000592:standards; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008508:Medication Errors; D008545:Melanoma / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010336:Pathology / Q000592:standards; D017410:Practice Guidelines as Topic; D012383:Romania; D021701:Sentinel Lymph Node Biopsy / Q000592:standards; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D013048:Specimen Handling; D019564:Unnecessary Procedures; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents