Company Press Release

American Academy of Dermatology Issues Patient Alert: Misdiagnosis of Skin Cancer Can Be Fatal

NEW YORK, April 26 /PRNewswire/ -- It's every patients worst fear -- ``you have cancer.'' But for Dorothy Tien Shaffer, a practicing psychologist, wife and mother from Ithaca, New York, these three words came seven years later when a mole on her leg -- originally diagnosed as benign -- turned out to be melanoma, the deadliest form of skin cancer. Although the cancer had already spread to her lymph nodes by the time it was diagnosed, Shaffer has responded to treatment so far. Others like Shaffer who have had misdiagnosed skin cancers aren't as lucky.

Speaking today at the American Academy of Dermatology's Melanoma/Skin Cancer Detection and Prevention Month Press Conference, dermatologist Mark Lebwohl, M.D., Professor and Chairman, Department of Dermatology, Mt. Sinai School of Medicine, New York, discussed the importance of using dermatopathologists -- doctors specially trained in clinically diagnosing skin biopsies -- rather than general pathologists for the accurate interpretation of skin slides.

Dermatopathology is a subspecialty of both dermatology and pathology in which skin biopsy specimens are interpreted microscopically. Doctors eligible to receive training in dermatopathology must be board certified in either surgical pathology or dermatology. In addition, dermatopathologists must also receive formal training in an accredited fellowship training program for at least one year.

Although they are the most qualified professionals to interpret skin biopsies, dermatopathologists are not always used because of restrictions by health insurance plans.

``The reason why pathologists are often interpreting skin biopsies rather than dermatopathologists is because managed care companies are more concerned with their bottom line than with providing the best possible care for their patients,'' said Dr. Lebwohl. ``Under many managed care plans, dermatologists are required to send skin biopsies to a laboratory mandated by the plan's contract rather than to the laboratory of their choice. When this happens, there is no guarantee that a dermatopathologist is interpreting the skin biopsy and any pathologist, regardless of experience, can end up reading these slides.''

An American Academy of Dermatology study found that more than 60 percent of its members worked with managed care companies that prevent them from sending skin biopsies to a dermatopathologist. In a joint statement issued by the American Academy of Dermatology and the American Society of Dermatopathology, the lack of appropriate training by pathologists at many managed care companies subjects the patient to a likelihood of having the skin biopsy specimen misinterpreted.

While managed care companies may save a little money up front by sending skin biopsies to laboratories that only employ pathologists, they will end up spending large sums of money to treat severe, life-threatening conditions -- such as melanoma -- that could have been avoided if a dermatopathologist had been used to analyze the specimen.

In the most serious cases, a skin cancer biopsy that is misdiagnosed as benign can spread throughout the body and be fatal if left untreated. On the other hand, there have been numerous cases in which a skin biopsy that is actually benign comes back from a pathologist as malignant.

For this reason, many dermatologists -- such as Dr. Lebwohl -- are dropping out of managed care plans that prohibit them from sending skin biopsies to dermatopathologists.

``If a melanoma is misdiagnosed, that is a deadly misread of a biopsy,'' warned Dr. Lebwohl. ``Personally, I was worried that if I continued in the managed care plan that eventually I would have a terrible misdiagnosis and a patient would be killed. Since I dropped out of the plan and have been using only dermatopathology labs, I have not had one problem.''

``I urge patients to be advocates for their own health care,'' added Shaffer. ``Don't hesitate to ask your doctor who is reading your biopsy, and don't be afraid to ask for a second opinion. Your life could depend on it.''

About 1.3 million new cases of skin cancer will be diagnosed in the United States each year. In 2000 alone, there will be about 47,700 new cases of melanoma and 7,700 deaths will be attributed to the disease.

The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of over 13,000 dermatologists worldwide, the Academy is committed to: advancing the science and art of medicine and surgery related to the skin; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care; and promoting a lifetime of healthier skin, hair and nails. For more information, contact the AAD at 1-888-462-DERM or www.aad.org .