Dermatologist Neglects to Perform Skin Biopsy Prior to Cryotherapy

This case involves a 62-year-old woman from Seattle who had a keratotic nodule that was being treated using cryotherapy for the course of a year. She never underwent a skin biopsy before or anytime during her treatment. After the treatment period, the patient came back to her dermatologist because she was concerned about a suspicious growth on her back. She complained that the growth was painful and itchy. It was later diagnosed as melanoma. It is alleged that the lesion should have been diagnosed earlier through a biopsy instead being treated with cryotherapy and that would have likely resulted in a better prognosis.

Question(s) For Expert Witness

1. How often do you perform/refer patients for skin biopsy?

2. What investigations should be ordered for a patient with a keratotic nodule that persists?

Expert Witness Response E-042624

As a practicing dermatologist, I routinely perform skin biopsies in my clinical practice. I also get referrals from other physicians for patients who need skin biopsies. In a patient with a keratotic papule, the standard of care for work up is a physical examination, dermoscopy, high-quality photography and treatment. They also require close follow-up to make sure the lesion is resolved and/or biopsy.