title: Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis.
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.
authors.affiliation: Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Essen, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sondermann
authors.forename: Lisa
authors.initials: L
authors.lastname: Zimmer
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
authors.forename: Alexander
authors.initials: A
authors.lastname: Roesch
authors.forename: Joachim
authors.initials: J
authors.lastname: Klode
authors.forename: Joachim
authors.initials: J
authors.lastname: Dissemond
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057210:Delayed Diagnosis / Q000009:adverse effects*; D003951:Diagnostic Errors / Q000009:adverse effects*; D005260:Female; D005528:Foot; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D055815:Young Adult