Delayed Skin Cancer Diagnosis Results In Complicated Removal


Skin Cancer Expert

This case involves a 56-year-old male patient who presented to his dermatologist with a mole on his chin. The dermatologist diagnosed him with an infected hair follicle, prescribed topical treatment, and recommended follow up in 2 weeks. During the follow up, the dermatologist informed the patient that the infection had cleared. The patient continued to experience swelling in the area and presented to the dermatologist 2 months later with the same complaints. The dermatologist ran a biopsy which revealed a basal cell carcinoma. A Mohs procedure was performed to remove the mole. The patient required substantial skin removal. As a result of the defect caused by the Mohs procedure, the patient required a skin flap to fix the carcinoma site.

Question(s) For Expert Witness

  • 1. Do you routinely evaluate patients with this clinical condition? Please explain.
  • 2. How common is it for basal cell carcinoma to metastasize?

Expert Witness Response E-060295

I have diagnosed thousands of basal cell cancers over my career as an academic clinical dermatologist. It is a common diagnosis in dermatology. Basal carcinoma almost never metastasizes, there are millions diagnosed every year and there are fewer than 100 cases of metastasis in the literature. Generally speaking, I counsel patients that risk of metastasis is infinitesimally small. I have published on the correct identification of biopsy site at the time of surgery using a patient’s cell phone. I have also published on a different, common skin cancer, squamous cell carcinoma.

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