Marrone Maricla, Caterino Cristina, Musci Gianluca, Cazzato Gerardo, Ingravallo Giuseppe, Lupo Carmelo, Casatta Nadia, Stellacci Alessandra, Armenio Andrea
Section of Legal Medicine, Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy.
Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", 70124 Bari, Italy.
Diagnostics (Basel). 2023 Mar 8;13(6):1033. doi: 10.3390/diagnostics13061033.
Malignant melanoma is a cutaneous malignancy resulting from the uncontrolled proliferation of melanocytes and poses a challenge diagnostically because neoplastic lesions can mimic benign lesions, which are much more common in the population. Doctors, when they suspect the presence of melanoma, arrange for its removal and the performance of a histological examination to ascertain its diagnosis; in cases where the dermatoscopic examination is indicative of benignity, however, after the lesion is removed, histological examination is not always performed, a very dangerous occurrence and a harbinger of further medico-legal problems. The authors present a court litigation case of an "alleged" failure to diagnose malignant melanoma in a patient who died of brain metastases from melanoma in the absence of a certain location of the primary tumor: the physician who had removed a benign lesion a few months earlier was sued, and only thanks to the presence of photographic documentation was the health care provider able to prove his extraneousness. The aim of this paper is to formulate a proposal for a dermatological protocol to be followed in cases of excisions of benign skin lesions with a twofold purpose: on the one hand, to be able to prove, in a judicial context, the right action on the part of the sanitarians; on the other hand, to avoid the rise of so-called "defensive medicine".
恶性黑色素瘤是一种由黑素细胞不受控制地增殖引起的皮肤恶性肿瘤，在诊断上具有挑战性，因为肿瘤性病变可能会模仿良性病变，而良性病变在人群中更为常见。医生怀疑存在黑色素瘤时，会安排将其切除并进行组织学检查以确定诊断；然而，在皮肤镜检查显示为良性的情况下，病变切除后并不总是进行组织学检查，这是非常危险的情况，也是进一步医疗法律问题的先兆。作者介绍了一起法庭诉讼案件，一名患者死于黑色素瘤脑转移，但原发肿瘤位置不明确，“据称”存在未能诊断出恶性黑色素瘤的情况：几个月前切除良性病变的医生被起诉，多亏有照片记录，医疗服务提供者才得以证明自己与此事无关。本文的目的是制定一份皮肤科诊疗方案建议，用于良性皮肤病变切除病例，其具有双重目的：一方面，在司法背景下能够证明卫生人员的正确行为；另一方面，避免所谓“防御性医疗”的增加。
