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Redundancy in reports as a double check


Mark A. Hurt MD

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Recently, I experienced the horror of an error on a report. The diagnosis was that of melanoma with a depth of 0.2 mm. My report stated, however, a depth of 2.0 mm!

I learned of this error when a very friendly oncologist called me and asked me about the Breslow measurement in relation to the T1a staging statement. Fortunately, from my report, I could tell what had happened.

In the microscopic description, I stated that most of the melanoma was in mostly situ. I went as far as saying that only a small portion of the melanoma was present in the papillary dermis.

In the diagnosis line, I stated it as follows:
Melanoma (T1a)
Breslow measurement: 2.0 mm
Clark Level II
No Ulceration
No mitotic figures identified in the dermal component

It should have stated the following:
Melanoma (T1a)
Breslow measurement: 0.2 mm
Clark Level II
No Ulceration
No mitotic figures identified in the dermal component

I have never been a fan of the AJCC system of TNM staging, but -- believe it or not -- I gained respect for it after this experience; if not only that as a redundancy, it prompted a call from the oncologist so that I could correct the report before a sentinel node biopsy and wider excision than necessary were performed.

I am still not a big fan of synoptic reporting. For me, a proper report always contains a microscopic description and a diagnosis with an interpretative comment (if necessary). In this particular case, there was a value in having a redundant system -- containing the TNM statement in the diagnosis -- so that an astute oncologist could take action on the illogical statement of my report. Kudos to him!
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Dr. Phillip McKee

Posted

Thanks Mark for sharing this problem. Although in the UK, I was used to writing long descriptive reoprts, I came to like the synoptic system as it ensured that I didn't forget anything. Sadly, I think we have all probably made the same mistake as yourself. We are all human.
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