Malignant Melanoma and Medical Malpractice

Each year, approximately 69,000 people in the United States will be diagnosed with malignant melanoma of the skin. As a disease that commonly affects young patients, malignant melanoma causes more lost life expectancy per death than almost every other cancer.  When diagnosed at an early stage, the prognosis for melanoma is quite good.  According to the Joint Committee on Cancer, when the lesion is deeper than 4 millimeters, or nearby lymph nodes are enlarged due to the melanoma, the prognosis for survival is  significantly diminished, especially when the outer layer of skin is ulcerated. iStock_000005950192Large-1.jpg

Allegations in a melanoma malpractice case may include a clinician’s failure to adequately biopsy a suspicious mole and/or improper interpretation of the biopsy by the pathologist.  Errors by the clinician include a biopsy of inadequate size (as is sometimes seen with shave and punch biopsies), a biopsy that has crush artifact, or the chosen  biopsy site does not adequately represent the lesion.  The ideal biopsy (if clinically practical) is when there is complete excision of the lesion surrounded by 2-3 millimeter margins of adjacent normal skin.  Errors by the pathologist include mishandling of the biopsy specimen and/or misinterpretation of the study.  Pathology reports that imply certainty on suboptimal biopsies may result in an unfortunate and deadly delay in diagnosis.

Communication of the patient’s history to the pathologist is sometimes essential to avoid a wrongful diagnosis in the lab.  It is not uncommon for an experienced clinician (knowing the history of a patient’s suspicious mole) to request step level analysis of the biopsy to make sure that deeper tissue levels are  studied for melanoma.  Another excellent practice is when a pathologist obtains an additional opinion or a second signature on the pathology report in an attempt to reach a proper diagnosis.

For additional facts, statistics, events and support groups related to melanoma, please see the American Melanoma Foundation.

Oral Cancer and Medical Malpractice

Oral cancer is the uncontrollable growth of cells that invade and inflict damage in areas involving the lips, tongue, cheek lining, floor of the mouth, gingiva, and palate. Men are twice as likely to have oral cancer, specifically men over the age of 40. Risk factors include smoking/tobacco use; heavy alcohol use; chronic irritation from rough teeth, dentures, or fillings; human papilloma virus infection; family history; excessive sun exposure; taking immunosuppressants that weaken the immune system; and poor oral hygiene. Oral cancer can present with a sore, lump, or ulcer in the mouth that initially is painless; however, as the cancer progresses it may evolve into a burning sensation or pain. The area may appear pale colored or it can be dark and discolored. Other symptoms include dysphagia (difficulty swallowing), odynophagia (painful swallowing), chewing problems, speech difficulties, lymphadenopathy (swollen lymph nodes), and weight loss.

iStock_000018882292XSmall.jpgTo diagnose oral cancer, your physician or dentist will examine your oral cavity and if a suspicious lesion is identified then an oral brush biopsy may be performed. The test is painless and involves isolating and analyzing a small sample of tissue for abnormal cells. However, if the lesion is more concerning then a scapel biopsy is recommended to determine whether the area is malignant or benign. X-rays and CT scans may be utilized to determine if the cancer has metastasized. Other tests that may be conducted include endoscopy, barium swallow, or PET scan. 90% of oral cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that line the lips and oral cavity. Squamous cell carcinoma often develops in areas of leukoplakia, white patches of cells that do not rub off. Other types of oral cancer include adenocarcinoma, lymphoma, melanoma, or teratoma.

If oral cancer is not diagnosed early, it can be life threatening. Treatment is dependent on the stage of the cancer which is determines by tumor size, lymph node involvement, and metastatsis. Surgery is recommended if the tumor is small enough and has not spread to the lymph nodes. Complications of surgery include disfigurement of the face, head, and neck. Often surgery is combined with radiation. Complications of radiation include dry mouth and dysphagia. When dealing with larger tumors, chemotherapy is recommended. Speech therapy is also essential to improve and retain movement, chewing, swallowing, and speech.

Depending on the presentation of the oral cancer, approximately 50% of individuals with oral cancer may survive greater than 5 years following diagnosis and treatment. If the cancer is identified early before significant metastasis, then the cure rate may be almost 90%; nevertheless, the majority of oral cancers have metastasized prior to diagnosis. One in four individuals with oral cancer will die due to delayed diagnosis and treatment. To prevent oral cancer, individuals should avoid smoking/tobacco, moderate or avoid alcohol use, and practice good oral hygiene