Vigilance to misleading information is required to avoid delayed diagnosis: Case series of acral melanomas
| Autor: | Adryan Kalya Ndraha Khairindra, Sumadi Lukman Anwar, Haryo Widhanto, Herjuna Hardiyanto, Suwardjo Suwardjo, Tania Maharani Chandra, Ery Kus Dwianingsih, Arini Rizky Wijayanti |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Acral Mucocutaneous zone Hyperkeratosis Physical examination Case Report Lesion 03 medical and health sciences 0302 clinical medicine Biopsy medicine History taking Medical history Melanoma medicine.diagnostic_test business.industry General Medicine medicine.disease Dermatology Dissection Misleading 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery medicine.symptom business Delayed diagnosis |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Introduction Melanoma is considered a rare cancer among Asians with a wide range of mucocutaneous manifestations. Failure to recognize a lesion as melanoma at first presentation might delay surgery aimed at complete resection. Acral melanoma has been related with the highest rate of misdiagnosis (~30%) causing further delayed diagnosis. Reliability of patient’ history taking in melanoma has not yet been systematically reported. Presented cases Two patients visited our oncology clinic with pigmented lesions in their soles. A 66-year-old man disclosed it appeared since a year ago after accidently hitting a stone while farming. Physical examination showed a black-brown irregular 100 × 80 mm lesion covering the distal third of the right sole with ulceration in the central lesion. The second patient was a geriatric woman with a black-purple 25 × 27 mm lesion with slight protrusion and ulceration in the central, irregular border, and partial hyperkeratosis. She explained the lesion emerged two years ago after she accidently stepped on a nail. Both patients were then diagnosed with acral melanomas and were treated with wide-excision, closure with skin grafting, and inguinal dissection. Discussion Both patients reported history of traumas in lesions later confirmed as acral melanomas. Although history taking can provide up to 80% of the information for accurate diagnosis, in ambivalent cases, careful anamnesis, clinical examination, and biopsy are required to confirm diagnosis of acral melanoma. Early disease identification to establish definitive diagnosis of cancer is generally associated with better clinical outcomes. In suspected cases, vigilance toward misleading information in history taking is required. Highlights • Acral melanoma is associated with higher rates of misdiagnosis than other melanoma subtypes. • Elderly patients often have chronic podiatric lesions associated with history of trauma. • Caution concerning misleading information during history taking is required to avoid delayed diagnosis of melanoma. • Biopsy is warranted for all undetermined skin lesions including unresolved wounds after standard treatment. |
| Databáze: | OpenAIRE |
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