Years ago, I handled a medical malpractice wrongful death case involving a man who died from malignant melanoma that started as a tiny spot in his thumbnail.
Melanoma is the most dangerous form of skin cancer. It starts in the melanocytes, or pigment-producing cells, of the skin. Melanoma is fast-growing and can generate deadly malignant tumors. Nearly 180,000 cases of melanoma will be diagnosed in the United States and 2018 alone.
When the man noticed a small discolored spot on his thumbnail, he did not wait long before seeing a dermatologist, a physician specializing in the skin. The dermatologist was concerned and performed a punch biopsy, which involved using a sharp cutting tool to remove the part of the nail and underlying tissue. The sample was sent to a dermatopathologist for analysis.
One of the important things for a dermatologist or other physician taking a biopsy to do is to make sure to remove a large enough sample to account for the outer edges, or margins, of the questionable growth. Without having the margins to view and analyze, is impossible to say for sure whether the melanoma cancer was localized or if it had spread.
When the dermatopathologist looked at this man’s biopsy, he noted in his report that it did not include the margins. Unfortunately, neither the dermatopathologist nor his office followed up with the dermatologist who ordered the punch biopsy. It is unclear whether the dermatologist ever read the report.
It is clear, though, that no one got in touch with the patient, so several months passed with him believing that everything was fine. In reality, this dangerous cancer was spreading up his thumb, into his forearm, through his upper arm, and to the axillary (armpit) region and its lymph nodes. Once the melanoma reached those lymph nodes, it spread throughout his body and eventually caused his death.
What should have happened is the dermatologist should have taken another punch biopsy and had it analyzed. This would have led to more aggressive treatment that would have likely saved this man’s life. Instead, he was a misdiagnosed and not treated.
What a tragic case.
The Skin Cancer Foundation recommends the patient’s lookout for the ABCDEs of melanoma.
· A is for asymmetry. Look at a mole or suspicious spot on the skin. If you drew a line through the middle, if the two sides do not roughly match, then there is an asymmetry, which can be a cause for concern.
· B is for border. Melanomas typically have uneven borders, rather than smooth ones.
· C is for color. Concerning moles do not have a uniform color, but rather a variety of them, including shades of brown, tan, and black—or even red, white, or blue.
· D is for diameter. Melanomas are typically larger than the eraser of a pencil tip. Watch out, though, because they can be smaller when they are first noticed.
Many people think of melanoma as affecting only the areas of the skin that are typically sun-exposed. The Cleveland Clinic recently wrote about five strange places where you would not expect a melanoma.
· Belly button.
· Under the nails. As discussed, I have seen this first-hand and a case.
· The eyes.
· Inside the mouth in the mucous membranes.
· The scalp.
Medical experts recommend seeing a dermatologist annually for preventative skin checks. Seeing the same provider allows comparison of any new growths year-to-year.
As a Houston, Texas medical malpractice attorney, I regularly review cases involving all types of misdiagnosis, including the failure of dermatologist to identify and treat melanoma.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.