This case involves a middle-aged female patient who was diagnosed with malignant melanoma. The patient first presented to a local dermatologist to have a suspicious mole on her right shoulder examined, at which point a biopsy was taken and the mole was treated with cryotherapy. The biopsy sample was examined at the lab, which determined that the mole was in fact a malignant melanoma. The patient was then referred to another physician, who attempted to excise the melanoma. After the melanoma was excised, it was sent to pathology, which indicated that the sample had clear margins and that the cancer had been successfully removed. A few months later, the patient again presented to a new dermatologist with a new spot located near the site of the original melanoma on her shoulder. The new dermatologist was not aware of the patient’s previous diagnosis and did not see the results of previous testing, and did not gather the patient’s history in this regard. As a result, the new lesion was misdiagnosed, and the patient’s new melanoma continued to develop and eventually spread.
Question(s) For Expert Witness
1. Do you routinely treat patients similar to the one described in the case?
Expert Witness Response
I have made the diagnosis of melanoma on a number of occasions and am familiar with what the standard of care involves regarding their staining. Most clinicians I know, when they have a patient with that diagnosis send them to surgical oncologists for resection, staging and the consideration of additional therapy. Follow up on these patients involves having a very high index of suspicion regarding subsequent lesions and the need for their biopsy. In this case, it was quite critical that the patient's prior history was looked into. It is quite routine. Before someone undergoes a surgical procedure based on pathology reports from outside institutions, the pathology slides are reviewed to be certain that, in fact, the patient has the tumor he/she are about to be treated for. Most institutions/hospitals have this policy in place.