Suspicious Lesion Goes Untested by Family Doctor

This case takes place in Illinois and involves a female patient who presented to her family doctor with a lesion on her right shoulder. The physician visually inspected the patient’s shoulder, but provided no diagnosis, instructing the patient to “keep an eye on it”. After a few months, the patient presented to the same doctor again, expressing her concerns about the same lesion. The family physician referred the patient to a dermatologist who took a biopsy of the lesion, at which point she was diagnosed with melanoma. She required extensive surgery on her shoulder to remove the cancer, resulting in the removal of significant muscle tissue and lymph nodes. It is alleged that the patient should have been referred to a specialist to inspect the lesion when she first showed it to her family physician.

Question(s) For Expert Witness

1. Do you routinely review biopsies of melanomas?

2. Can delay in diagnosis of this length worsen the outcome for a patient?

Expert Witness Response E-005950

Yes I routinely review biopsies of nodular melanomas in my capacity as a board-certified dermatopathologist. I diagnose approxmately 20-30 cases of melanoma per year at our University Medical Center. I view skin cases daily on service and do clinical research in the local immune mechanisms of melanoma. In general, early detection is key for the best possible outcomes for many types of melanomas. Some melanomas are metastatic at the time of diagnosis. Melanomas of this variety have, by definition, metastatic potential at the time of diagnosis as they are in vertical growth phase. Most melanomas on this part of the body are the acral lentigenous type, which in general spread along the epidermis for some time prior to invading the lymph nodes. The histologic type of melanoma is key to this case as the propensity for growth (radial versus vertical) is important in how delay may affect patient care. It would seem that the delay in this case would have lead to a significantly worse outcome for the patient.