THE EFFECT OF MISDIAGNOSIS AND DELAY IN DIAGNOSIS ON CLINICAL OUTCOMEIN MELANOMAS OF THE FOOT

BACKGROUND: Melanoma of the foot is often discussed as an uncommon tum or which, when it occurs, presents in nonwhite races. STUDY DESIGN: Th e tumor registry of a 650 bed community teaching hospital and the Conn ecticut Tumor Registry were retrospectively reviewed for the nine-year period from July 1980 to July 1989. Patient age, race, sex, incidence of misdiagnosis, and delay until definitive therapy were recorded. Tu mor location, size, staging, follow-up, recurrence, and disease-free s urvival rates were also recorded and correlated with initial disease, stage, and misdiagnosis or delay. RESULTS: Twenty-six cases were ident ified at Bridgeport Hospital, and 140 cases were identified in the Con necticut Tumor Registry. Significant delay in diagnosis occurred in 68 percent of the cases from the hospital and at least 16 percent of the cases in the state tumor registry. Regardless of stage, melanoma of t he foot had a worse prognosis than melanoma of the thigh and lower leg . Delays in diagnosis had no demonstrable effect on clinical outcome. CONCLUSIONS: Melanoma of the foot is not as rare as commonly suspected , and constituted 3 percent of the 4,562 melanomas reported in the sta te tumor registry for the nine-year period. The majority were in fair- skinned individuals, and misdiagnosis was common. It is the inherent a ggressiveness of the tumor rather than the delay in diagnosis that acc ounts for the poor clinical outcome.