Dermatologist Does Not Request Testing For Patient With Recurrent Cancer

This case involves a middle-aged female patient that was diagnosed with recurrent basal cell cancer. After several years of treatment, the patient informed her dermatologist that her chest had become disfigured. The patient’s dermatologist noted that there were changes to the patient’s chest secondary to radiation, but no further testing was performed. 6 months later, the dermatologist noted significant changes in the patient’s appearance and prescribed a topical medication. In spite of the medication, the patient returned later with worsening symptoms. A biopsy was requested and resulted in a diagnosis of advanced stage recurrent basal cell carcinoma. The patient’s cancer had become so pervasive that it had affected nearby bones. Surgical intervention and resection were required.

Question(s) For Expert Witness

1. Please describe your background in dermatology.

2. In a patient with a history of recurrent basal cell carcinoma, what type of presentation would warrant further testing?

Expert Witness Response

I am an expert in squamous and basal cell carcinoma. My practice is 100% skin cancer and all my clinical activities encompass seeing patients with skin cancer for medical and surgical management. In a patient with recurrent basal cell carcinoma (BCC), the clinical exam is generally what warrants further examination. BCC is a local recurrence, so clinical skin exam is usually enough to lead to suspicion and biopsy for recurrence. If there is concerning symptoms like pain or disfigurement, this would also lead a clinician to proceed with biopsy or radiology imagining to work up for recurrence locally or distantly. Usually, patients with garden-variety BCC see a dermatologist once or twice a year for full body skin exams. If a patient is lost to follow-up, it is difficult to monitor the patient. If there is suspicion for recurrence, close monitoring every 3 months should be undertaken. BCC is a slow growing lesion so every 3 months is generally enough even for the most aggressive of BCC unless they are already locally advanced or metastatic, in which case once a month is generally undertaken.