Dermatology Experts Discuss Inadequate Testing of Skin Lesion

This case involves a male patient who had been under the care of a dermatologist for several years in order to monitor a number of pre-cancerous moles on his back. During this time, the patient developed a new mole on his nose that changed character over the years that the man was seen by the dermatologist. At some point, the doctor claims to have taken a skin shave biopsy of the suspected lesion which turned up negative. A year later, the man saw a new dermatologist on the recommendation of his primary care provider. This doctor diagnosed the lesion as cancerous, and subsequent testing revealed a number of metastases.

Question(s) For Expert Witness

1. When is shave biopsy recommended for a lesion?

2. When is a punch biopsy indicated?

Expert Witness Response E-060295

A shave biopsy should have been entertained as soon as the lesion changed or when the patient said that lesion was changing. a shave biopsy would have likely ascertained the diagnosis, though it is unclear why it may not have in this instance. A punch biopsy on the nose can be cosmetically difficult, so generally in my opinion only if I am worried about a deep lesion or if a shave biopsy does not give a diagnosis would I recommend the more invasive punch biopsy.