Melanoma : A Frequently Missed Diagnosis.

In ‘An unforgivable delay’ in the Lancet 2005 Jan 29 issue, a psychiatrist acknowledges, how as a young internist he dismissed an inguinal soft tissue swelling in a middle-aged lady, as a ‘lipoma’ and to his chagrin, realized later, that it was a melanoma! [1]. The confessional prompted this review in view of recent similar experiences with diagnosis of this tumor. Malignant melanoma is an aggressive tumor of melanocytes commonly encountered as cutaneous malignant melanoma (CMM) in fair-skinned individuals predisposed to it by ultraviolet exposure. Fewer cases present as ocular melanomas or malignant mucosal melanoma (MMM) [2, 3]. India enjoys a low incidence of melanoma [4, 5, 6], which could be due to under-reporting of melanoma on account of a low index of suspicion by clinicians and pathologists alike. This is particularly true when a cutaneous lesion lacks pigmentation or an ocular or mucosal melanoma is occult and presents as metastasis. This may lead to a missed or delayed diagnosis and delayed therapy. We draw the attention of the reader to the possible underreporting of melanoma because of our reluctance to ‘think’ about its existence; compounded by a variant morphology that evades diagnosis. Four recent cases highlighting the clinical and diagnostic aspects of melanoma are discussed.