Dermatology Experts Evaluate Repeated Failure to Diagnose Melanoma

Case Overview

This case involves a female patient in Montana who was diagnosed with advanced melanoma. The patient had a known family history of melanoma, and her mother died from it a few years before the events in this case. The patient had a lesion which had been diagnosed as seborrheic keratosis on her back, which had been treated with liquid nitrogen on several occasions. On one occasion, the patient presented to the Defendant and reported that the lesion had changed, though no action was taken. The patient returned to the Defendant again some time later, with the lesion still present. The patient presented to a new dermatologist a few months later, and a punch biopsy was performed that same day. The biopsy results revealed the lesion to be a malignant melanoma. The patient then underwent a biopsy that revealed a metastatic melanoma that had spread to multiple lymph nodes. It is alleged that the patient would have had a better outcome if her cancer had been diagnosed sooner.

Questions to the Dermatology expert and their responses

Do you routinely treat patients similar to the one described in the case?

I specialize in the management of melanoma and non-melanoma skin cancers, and have been doing so for the past 20 years. I routinely treat patients with in situ and thin (< 1mm) melanomas, and I am a part of a multidisciplinary tumor board that sees patients with melanoma requiring multidisciplinary management.

Have you ever had a patient develop the outcome described in the case?

I personally have had one or two patients develop melanoma metastases from melanomas in the 0.75 to 1 mm thickness range, who were treated with excision alone, before sentinel lymph node biopsy became standard practice.

Would the patient's current prognosis been different had the cancer been diagnosed sooner?

The patient's prognosis would likely have been different had the cancer been diagnosed during her earlier visit as opposed to the visit on which the biopsy was performed. In all similar cases that I have reviewed, a delayed diagnosis of melanoma resulted in metastatic disease and in some cases, death.

About the expert

This highly qualified expert earned her M.D. from Johns Hopkins University and went on to do her Residency in Dermatology and her Fellowship in Mohs Micrographic Surgery & Cutaneous Oncology. She is the Co-Editor of the Dermatologic Surgery Journal, and is an Editorial Board member for the Journal of the American Academy of Dermatology. She has authored or co-authored more than one hundred publications, and has given over 100 presentations at national and international meetings. She has been listed as one of the Castle Connolly's Top Doctors since 2005, and is one of the New York Times Best Doctors and America's Top Surgeons since 2009. She currently serves as a Professor of Dermatology & Professor of Clinical Dermatology at a Top-ranking University and Director of a leading Skin Cancer Center & Director of Dermatologic Surgery at a Top-ranking University-affiliated Medical Center.