This case takes place in New Jersey and involves a Mohs procedure. After the procedure, the patient developed what the dermatologist thought was a cyst. The dermatologist lysed the cyst, but did not send the biopsy to pathology. He was prescribed antibiotics and given a steroid injection. Months later, the patient was referred by the dermatologist to an ENT who found her ear canal to be swollen shut. He referred the patient to an ENT specialist who ordered and emergent CT, ultrasound, and biopsy. It was positive for invasive squamous cell carcinoma. The patient was referred to another hospital where she underwent numerous surgical procedures. The patient was immunocompromised and on Gleevec when the Moh’s procedure was performed. This physician had been following the periauricular area in the past and was aware of his immunocompromised state.
Question(s) For Expert Witness
- 1. Do you routinely perform MOHS surgery?
- 2. Do you have experience with patients like the one described in this case?
- 3. Have you ever had a patient develop this outcome?
- 4. Have you ever served as an expert witness?
Expert Witness Response E-009019
I have performed Mohs surgery for over 25 years and I have published and lectured extensively on Mohs surgery. Immunosuppressed patients are at higher risks of spread and metastatic disease from squamous cell carcinomas. I have never had a patient develop this outcome and have never been the target of a malpractice claim. I have testified as an expert witness numerous times regarding medical malpractice related to the MOHs procedure.
Expert Witness Response E-010217
I am a member of the American Society for Mohs Surgery and practice Mohs Surgery routinely one day a week in my practice. A large portion of my practice consists of immunosuppressed patients (bone marrow transplants, solid organ transplants, autoimmune conditions). I have served as an expert witness several times before with The Expert Institute and have published and lectured about skin cancer in the immunosuppressed patient.