Delayed Diagnosis of Basal Cell Carcinoma Leads to Complicated Surgical Intervention
A delayed diagnosis of a skin lesion highlights the critical impact of timely evaluations on patient outcomes in cases of basal cell carcinoma.
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Case Overview
This case involves a 60-year-old individual who presented to a plastic surgery physician assistant with a forehead lesion. Initially, a provisional diagnosis of actinic keratosis was made during the visit. However, over the course of five years, the patient did not receive evaluations by a physician during follow-up appointments. It wasn't until a biopsy was performed at a different institution that a confirmatory diagnosis of nodular basal cell carcinoma (BCC) was established. Subsequently, the patient underwent a three-stage Mohs surgery to address the lesion. This case raises significant concerns about the implications of delayed diagnosis and intervention on patient outcomes, particularly in cases of basal cell carcinoma.
Questions to the Dermatology expert and their responses
How does timeliness to diagnosis and intervention typically affect patient outcomes in cases of basal cell carcinoma?
Timeliness is key to the patient's outcome. BCC's detected earlier when they are small are more easily treated and require fewer stages of Mohs micrographic surgery for their removal. A delay in diagnosis allows BCC's to grow larger which results in larger Mohs surgery defects, and often more stages of Mohs surgery to clear the tumor, and ultimately larger and more complex repairs/reconstructions with larger scars.
How does timeliness to diagnosis and intervention typically affect patient outcomes in cases of basal cell carcinoma?
My approximate split between plaintiff and defense work is 80% plaintiff and 20% defendant.
About the expert
This expert has over 25 years of experience in the field of dermatology, specializing in Mohs surgery. He earned his BS from Carnegie Mellon University, followed by his MD from the University of Pittsburgh School of Medicine. He then completed a residency in dermatology at Rush Presbyterian St. Luke’s Medical Center and a fellowship in Mohs surgery at the Baptist Medical Center. Today, this expert is board certified in dermatology with a subspecialty in micrographic dermatologic surgery. He is a member of several professional organizations, including the American College of Mohs Surgery, the American Academy of Dermatology, and the American Society of Dermatologic Surgery. He is also active in academia, having published 15 peer-reviewed journal articles. This expert previously was an associate professor of dermatology, the director of Mohs micrographic and dermatologic surgery, and the coordinator of clinical operations at the Rush University Medical Center. Most recently, he worked as a medical and surgical dermatologist at Darien and Skokie Hospitals and St. Joseph Dermatology. Currently, he is the chief of dermatology at a medical center, a surgical dermatologist at two dermatology practices, and the medical and surgical director of Mohs micrographic surgery at a surgery center, all located in Illinois.
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