Delayed Skin Cancer Diagnosis Results In Complicated Removal

This case involves a 56-year-old male patient who presented to his dermatologist with a mole on his chin. The dermatologist diagnosed him with an infected hair follicle, prescribed topical treatment, and recommended follow up in 2 weeks. During the follow up, the dermatologist informed the patient that the infection had cleared. The patient continued to experience swelling in the area and presented to the dermatologist 2 months later with the same complaints. The dermatologist ran a biopsy which revealed a basal cell carcinoma. A Mohs procedure was performed to remove the mole. The patient required substantial skin removal. As a result of the defect caused by the Mohs procedure, the patient required a skin flap to fix the carcinoma site.

Question(s) For Expert Witness

1. Do you routinely evaluate patients with this clinical condition? Please explain.

2. How common is it for basal cell carcinoma to metastasize?

Expert Witness Response E-060295

I have diagnosed thousands of basal cell cancers over my career as an academic clinical dermatologist. It is a common diagnosis in dermatology. Basal carcinoma almost never metastasizes, there are millions diagnosed every year and there are fewer than 100 cases of metastasis in the literature. Generally speaking, I counsel patients that risk of metastasis is infinitesimally small. I have published on the correct identification of biopsy site at the time of surgery using a patient's cell phone. I have also published on a different, common skin cancer, squamous cell carcinoma.