Delayed Diagnosis of Melanoma Leads to Tragic Outcome for Inmate

Case Overview

This case revolves around a prison inmate whose medical history includes a notable mole on their right cheek. During the intake process, this mole was recorded at 0.5 cm in size. A subsequent periodic health assessment revealed that the lesion had enlarged to 1.1 cm. This prompted a referral to dermatology, leading to a telemedicine consultation where the dermatologist observed the lesion's irregular borders and noted its growth. The recommendation for an in-person visit was made, which occurred several weeks later. At that visit, the lesion was identified as seborrheic keratosis, and electrocauterization was performed, with a follow-up suggested in six weeks. Unfortunately, the patient was not brought back for this follow-up. Subsequent examinations in March revealed new lumps on the neck, and by June, testing confirmed metastatic melanoma. The patient underwent aggressive treatment, including surgery and radiation, but ultimately succumbed to the disease. This case raises critical questions about the standard of care and the implications of delayed diagnosis in the context of melanoma.

Questions to the Dermatology expert and their responses

How often do you see patients with lesions on the face?

I treat patients with facial lesions every day.

Generally, what should be done when there is a lesion on a patient's face that has been growing over time?

If a lesion has been growing, and especially if a significant change in size has been noted, a biopsy should be performed.

About the expert

This expert has over 25 years of experience in dermatology, specializing in melanoma, non-melanoma skin cancer, and Mohs Surgery. She earned her BA from Brown University and her MD from Johns Hopkins. She then completed an internship in internal medicine at Beth Israel Hospital, a residency in dermatology at the University of Michigan Medical Center, and two fellowships in Mohs micrographic surgery and cutaneous oncology at Tufts-New England Medical Center and Lahey Clinic Medical Center, respectively. Today, this expert is board certified in dermatology. She is a member of numerous professional organizations, such as the American Society of Dermatologic Surgery and the American College of Mohs Micrographic Surgery and Cutaneous Oncology, and has published more than 100 peer-reviewed articles. She previously served as a professor of clinical dermatology at Columbia University and as the director of dermatologic surgery at Mount Sinai Beth Israel Medical Center. Currently, she is a professor of dermatology at two top medical universities, a voluntary attending dermatologist at a university-affiliated hospital, and a dermatologist and owner of a private practice in New York.

E-011913

Specialties:

Dermatology