Patient Develops Fatal Infection Following Skin Graft

    This case involves a 45-year-old male patient who developed actinic keratosis on his shoulder blade after prolonged sun exposure.  The patient’s dermatologist elected to treat the patient with cryotherapy. After the patient’s actinic keratosis was removed, the wound began to fester. The patient returned to the dermatologist’s office and was prescribed a topical burn cream. The patient used the burn cream for several weeks but saw no improvement. The actinic keratosis site eventually became infected and the patient ultimately required a skin graft. Following the skin graft, the patient was instructed to follow up every 2 weeks for 2 months. The first follow up appointment showed the patient was healing properly. By the second appointment, however, the patient had developed a subsequent infection in the graft. The patient was instructed to go to the hospital. While the patient was in the hospital, he became septic and died.

    Question(s) For Expert Witness

    • 1. Do you regularly treat actinic keratosis with cryosurgery?
    • 2. What complications may have caused the patient's outcome?

    Expert Witness Response E-008742

    I am a renowned dermatologist with 30+ years of experience in the field. I currently serve as professor and chief of dermatology at a major university medical center. I regularly treat actinic keratoses, and I have a specific research interest in patients with infection. In this particular case, there are a few issues that need to be addressed. Did the patient have a known diagnosis of infection prior to the treatment of the AK? Was there a concern that the AK might be an early squamous cell? If yes, then a discussion of the possibility of infection should have occurred. That discussion would not, however, prevent me from treating a lesion that needed to be treated and biopsy or other methods might have also resulted in infection. Finally, did the patient have any other known medical problems? Complicating issues could include inflammatory bowel disease, myelofibrosis, or leukemia.

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