Years ago, I was an attorney in a medical malpractice suit involving a man whose problems began with a small speck on his left thumbnail. When he said small, he explained that he meant not much larger than the sharp end of a needle.
He kept an eye on it and noticed that it was starting to get a little bigger, so he went to see his dermatologist. Dermatologists are doctors with specialized training in diseases and conditions of the skin, including the dreaded disease melanoma, or skin cancer.
The small spot on his thumbnail captured enough of the dermatologist’s attention that she decided to do a punch biopsy to rule out cancer.
A punch biopsy is a medical procedure in which the doctor uses a medical device to punch through some part of the body, in this case the patient’s thumbnail, and remove a portion of tissue. The tissue sample is then sent off to a pathology lab for careful review under a microscope.
When doing a biopsy to rule out cancer, it’s important that the tissue sample is wide enough to capture all the margins or borders of the suspicious area. In this case, the dermatologist took a sample that was too small. You can imagine what happened next.
The pathologist reviewed the limited tissue sample and didn’t see anything suspicious. The dermatologist passed along that news to her patient, who then went on with life.
Months passed and the man started having more symptoms. He went from doctor to doctor to try and figure out what was wrong. Eventually, a specialist figured out that the tiny spot on his left thumbnail was an aggressive melanoma that had spread up his thumb, through his hand and arm, and up to the axillary (armpit) region, where it invaded the lymph nodes and went all over his body. In short, this mistake was a death sentence – this man, who was more careful and diligent than most people, needlessly died.
According to medical malpractice claims data from the Medical Professional Liability Association spanning the time period of 2006–2015, the top medical factors in claims against dermatologists include improper performance of procedures and errors in diagnosis.
The same data show that the top outcomes based on these mistakes include dyschromia, which is alteration of skin or nail color, malignant neoplasms of the skin, and malignant melanoma.
Skin cancer and malignant melanoma
As an adult who spent a lot of time outside in the 70s and 80s as a child, some of the statistics from the Skin Cancer Foundation grabbed my attention:
• Over three million people in the United States were treated for non-melanoma skin cancer.
• There are more skin cancer diagnoses each year in America than for all other cancers combined.
• There are nearly 200,000 cases of melanoma diagnosed in the U.S. annually. About half are limited to the top layer of skin (epidermis), and about half penetrate into the second layer of the skin (dermis).
• 20 percent of Americans will develop skin cancer by the time they’re 70 years old.
• Having five or more sunburns doubles your risk for melanoma.
• Just one instance of having a blistering sunburn as a child or teenager more than doubles the chance of developing melanoma later in life.
Malignant melanoma is the most dangerous type of skin cancer. Close to 90 percent of melanomas are caused by UV exposure from sunlight, which impacts the pigment-producing melanocytes that determine skin color.
As the medical community’s understanding of what causes malignant melanoma has developed, there have been recommendations of applying sunscreen products before spending time outside. You may have noticed that some playgrounds even have sunscreen dispensers for children. This is important because UV exposure in children catches up with those individuals as adults.
Of course, these sobering statistics mean that people of all ages should avoid tanning beds and apply generous amounts sunscreen when spending time outside in the sun.
Medical experts also recommended people pay close attention to changes in their skin condition. Dermatologists recommend annual skin checks. Using the same dermatologist allows establishing a baseline of your skin condition that can be used for comparison purposes on future skin check visits each year.
As with so many things in medicine, early diagnosis and treatment is critical. Perhaps the one bit of good news from the Skin Cancer Foundation is that early diagnosis and treatment of melanoma has a 99 percent five-year survival rate.
For small areas of malignant melanoma cancer, the treatment is typically going to surgery for excision or removal of the cancerous tissue. The standard of care requires dermatologists to remove enough tissue to ensure that no microscopic cancer is left at the margins or edges of the cancer. When this is not done, it allows that microscopic cancer to continue to grow and potentially metastasize to other parts of the body. This can have deadly consequences. The amount of the tissue that the dermatologist needs to remove depends on the width, thickness, and location of the cancer.
When a dermatologist suspects that the cancer may have metastasized (spread), though, there may be additional exploratory surgery to check for lymph nodes. More advanced melanomas may require treatment with medications, chemotherapy, or radiation therapy.
If you’ve been seriously injured because of poor care from a dermatologist, or delayed diagnosis and treatment of skin cancer, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.