Man Suffers Permanent Disfigurement from Botched Mohs Procedure

This case involves a middle-aged man who underwent a Mohs procedure in order to remove a cancerous lesion from the skin of his face. The lesion was removed from underneath his left eye on the ridge of his cheekbone, and the procedure began with a conservative approach initially. However, as the procedure progressed the margins were steadily increased, until a substantial section of skin was removed. The patient was left with a conspicuous deformity as a result, and it was later claimed that the removal of tissue was too aggressive for his diagnosis.

Question(s) For Expert Witness

1. How often do you perform Mohs skin cancer surgery?

2. What can be avoided to remove unnecessary layers of skin during the surgery?

Expert Witness Response E-028773

My clinical practice only involves Mohs surgery and skin cancer care. I perform Mohs 2 times a week and see patients otherwise for only skin cancer issues. My clinical expertise is in high-risk skin cancer. Previously I served as the Director of Dermatologic Surgery at a major university where I directed the High Risk Skin Cancer clinic. I currently run the High Risk Skin Cancer Clinic at a major west-coast medical center. My research and clinical interest are in aggressive skin cancers. Proper surgical technique and review of histology is the best way to prevent unnecessary layer removal. Evaluating a lesion and the initial biopsies are critical to planning the surgery. During surgery, review of histology is critical and making sure that proper processing provides high-quality slides during each stage so unnecessary stages are not needed and further layers taken. I have reviewed multiple cases where margins were inappropriately called clear.