Skin cancers are the most common of all cancers and the most curable of all.  The most common types of skin cancers are basal cell, squamous cell and melanomas, each of which is 100% curable by simply removing the cancerous lesion before it advances or spreads.

People who have an increased risk for developing skin cancer, and who have a need for heightened surveillance, include those:

• Whose work or recreation (including tanning in tanning bed) that resulted in prolonged sun exposure;
• Who have alot of moles or birthmarks;
• Who have family members who have had skin cancers, which suggests that they have a  genetic predisposition for developing skin cancers;
• With fairer skins;
• Who suffered blistering sunburns in childhood,
• Who had more than five burns over the course of their lives;
• Who had skin cancer(s) in the past;
• Who have weakened immune system from chemotherapy, HIV, other cancers or other causes.

Why does a Delay in Diagnosis of Skin Cancer Occur?

1. Improper Surveillance

Patients need to perform a monthly examination of their own skin and report growths and discolorations to their physicians, who in turn have a duty to examine them and determine whether skin lesions warrant additional analysis.  People who are at elevated risks for developing skin cancers may warrant yearly, or possibly every six month, surveillance by a dermatologist.  Unfortunately, patients' follow-up visits are missed due to failure to inform the patient of their risk and the need for follow-up, scheduling SNAFUs, etc, and precancerous growths than evolve into cancers outside the watchful eye of the vigilant physician.

Another type of problem occurs even when patients return for routine follow-up.  While it seems logical that physicians and other providers who perform your health maintenance care would keep track of whether moles and lesions are changing or growing, there is no standard method to record and follow skin changes.  Some physicians take photographs of skin growths and discolorations with rulers beside the lesions for size references; others mark X's on pictorial outlines of the body to note the sites of lesions of concern; they may document the appearance of lesions with written descriptions and measurements.  Still others fail to document skin lesions at all, so have no means to follow them for growth and changes over time.  Haphazard follow-up of skin lesions predisposes patients to having late diagnoses of skin cancers.

2. Improper management of skin lesions

Removing a skin lesion is such a technically simple procedure that medical physicians without any experience in dermatology or any surgical training are often tempted to burn off a wart-like growth or do a simple excision of something that appears like a cyst or clogged duct. Serious and aggressive skin cancers can masquerade as warts and cysts.  For example, melanomas that grow out of the pigment of the skin are not always colored. 

All skin lesions deserve careful assessments and proper excisions, and this is especially so in people at a higher risk for developing skin cancer.  Some cancers require wide tissue excisions of tissue surrounding the lesions, and some cancers are so aggressive that the excision of lymph nodes that drain the vicinity of the lesion should also be performed when those types of cancers are diagnosed.

Dermatologists are sufficiently skilled to perform many excisions, but may stretch and perform an excision that should have been performed by a surgeon.  Management of skin cancers by physicians, even surgeons who are not specialists in skin cancer care, places patients at risk for improper management of their skin cancers.

2. Failing to send specimens for pathologic analysis (biopsy)

In the name of cost saving, or maybe just saving time, physicians, even dermatologists and   surgeons may feel that a lesion looks benign, so that they do not need to send it to the pathology laboratory for further analysis.  They learn through patient's bad outcomes, that a cancer cannot be diagnosed or ruled out by its appearance alone.  As a general rule, anything removed from the skin should be biopsied.

2. Abnormal laboratory reports are miscommunicated or misfiled:

If a cancer is found, the pathologist or technician examining the sample must convey the finding to the doctor who ordered the study, who must communicate the need to recall the patient to the doctor's scheduler, who must reach the patient and communicate a need to return to the physician's office to get additional treatment to make sure that the cancer has been properly treated.  There are many steps in this process where errors may occur.  It is easy to "slip through the cracks."

All of the facilities involved must have procedures to assure that the patient actually receives the message and returns for appropriate follow-up testing.  Failures on the part of the diagnostic laboratory where the skin cancer specimen was examined, and/or your provider's office have resulted in failures to recall patients for necessary follow-up.

Common Issues of Negligence:

The most common allegations of negligence in skin cancer cases are:

• Failing to perform visual inspections as surveillance for skin cancer;
• Missing the warning signs of precancerous changes or small skin cancers in high risk patients;
• Insufficient surveillance and vigilance of monitoring high risk patients;
• Failing to document suspicious lesions so that they are properly followed over time to appreciate growth and changes in appearance;
• Failing to properly remove and biopsy suspicious lesions;
• Failing to perform wide tissue excisions and/or lymph node resections as per the standard of care for aggressive cancers that are known to metastasize rapidly;
• Failing to send tissue specimens to the pathology department for microscopic analysis;
• Promoting patient complacency by failing to provide education and support;
• Improperly staging the cancer, once it is discovered;
• Providing improper treatment of the skin cancer;
• Failing to provide continuing surveillance to pick-up a recurrence of the cancer or metastasis;
• Prescribe additional diagnostic testing in response to equivocal or suspicious physical findings or testing.
   

Injuries and Damages:

Timely diagnosis of a skin cancer may require only a local excision of tissue.  In contrast, diagnostic delays can lead to the need for a disfiguring surgery because of  extension of the cancer into surrounding structures, or worse, the need for chemotherapy and radiation therapy due to the spread of cancer to other parts of the body.

When a serious delay allows the spread of the cancers so that the patient's "stage" at the time the cancer is diagnosed is higher, treatments become more complex and dangerous.  Late diagnosis with a more advanced stage of cancer may lead to a worsened prognosis or death from the cancer. 

Conclusion:

Skin cancer is a curable cancer if diagnosed and excised in a timely manner.  Late diagnosis can cause severe disfigurement and may even prove to be deadly.  When a skin cancer is not diagnosed until it is advanced in a person who gets regular health maintenance care, the delay in diagnosis is likely to be due to negligence.

 If you fear that substandard medical care or outright errors resulted in a delay in detecting your cancer, or caused complications in your cancer care that hurt your chance of recovering, I will look at your case free of charge, and tell you if you may have been the victim of medical malpractice.  If your case is outside our jurisdiction, we can help you to find skilled and ethical counsel in your area.

Mark R. Bower, Esq