Skin Cancer Misdiagnosis
Skin cancer is the most common form of cancer in the United States. Thankfully, most skin cancer is relatively harmless. But, in a minority of cases, skin cancer can be lethal. In too many cases, the difference between minor and deadly is the misdiagnosis of a doctor, usually a patient's primary care doctor, who steps over signs and symptoms of skin cancer.
If you or a family member had skin cancer that you believe was misdiagnosed, call 800-553-6000, or get a free online consultation for your potential malpractice claims.
- Maryland cancer misdiagnosis settlements and verdicts
- A look at a 2016 lawsuit against a dermatologist in Howard County
The most common types of skin cancer are melanoma, and basal and squamous cell. There are also other more rare forms of skin cancer such as Merkel cell carcinoma. Approximately 87,000 Americans are diagnosed with melanoma each year, positioning itself as the sixth most common form of cancer in the US. An additional 48,000 Americans are diagnosed each year with a form which involves only the outermost layer of the skin.
Further, two million people are treated for basal cell or squamous cell skin cancer annually. Malignant melanoma is an aggressive and often fatal form of skin cancer. It is also the second most misdiagnosed form of cancer. Melanoma represents only 4% of all skin cancers but accounts for 73% of all skin cancer deaths. It is estimated that approximately 9,730 deaths will occur in 2017 (65% of these will be men). Early stage diagnosis and treatment provides the best chance for cure.
In 2017, it is estimated that approximately 87,000 Americans (52,000 men and 34,000 women) will develop cutaneous melanoma, and nearly 47,000 will develop melanoma in situ. It is important to note that incidence may be higher due to under-reporting. The risk of developing melanoma is 1 case per 57 Americans and increases to 1 case per 33 if non-invasive melanoma in situ is included. Incidence has continued to rise throughout the world especially in Australia and New Zealand.
Further, prevalence is higher in white Caucasians than African Americans and Hispanics. However, mortality rates are higher in African Americans and Hispanics. It is also noteworthy that invasive melanoma is more prevalent in women than men in people under 40 years of age, but more common in men 40 years of age and older.How Misdiagnosis Occurs
Visual inspection is often used to distinguish melanoma with other skin pigmentation changes. Experienced visual inspection is often the key to distinguishing a melanoma from other pigmentation changes. An ABCDE system was developed by the American Cancer Society to serve as a guideline for early melanoma warning signs as follows:
A = Asymmetry (opposite segments are different)
B = Border (border of melanoma is usually irregular
C = Color (variation in color)
D = Diameter (diameter greater than 6mm, but it is also possible to diagnose smaller melanomas)
E = Elevation (though easier to diagnose elevated melanomas, outcomes are better when diagnosed flat)
Skin cancer shares symptoms with some other diseases which can lead to misdiagnosis. For doctors who are lax and do not believe in ruling out all of those less serious diseases, a skin cancer misdiagnosis can have grave consequences. Skin cancer is the second most misdiagnosed cancer, behind breast cancer. It is imperative that further tests be performed to confirm the diagnosis of skin cancer or second opinions are sought. For example, bumps or lumps under the skin may be misdiagnosed as pimples, warts, cysts, or lipoma (flat tumor), and changes in the skin's condition such as a sore or growth may be misdiagnosed as a skin infection or another non-cancerous symptom.
Similarly, misdiagnosis of basal cell carcinoma occurs. In a recent review of the literature, it was reported that vulvar basal cell carcinoma is often misdiagnosed as appearance mimics eczema or psoriasis. The main symptom is itching which often gets dismissed as an irritation and leads to inappropriate treatment. This article highlighted the need to recognize that both melanoma and basal cell carcinomas occur in areas that are not typically exposed to UV radiation (i.e., lower body including genitals and feet), which further complicates measurement of risk and diagnosis.
Misdiagnosis may include improper evaluation of symptoms or incorrect interpretation of biopsy histopathology reports or the misdiagnosis of skin cancer as other diseases or inflammatory responses which lead to delays in identification. With early diagnosis being one of the most important factors in a positive outcome, a delay in proper identification can be fatal. Misdiagnosis may also include a symptom or change in the skin which is diagnosed as cancer in haste. In such cases, patients undergo surgeries to remove these 'so-called' carcinomas when in fact it was not necessary. Further, metastasis of melanoma to other organs is often misdiagnosed. For example, it is plausible for melanoma to metastasize to the stomach, but when masses are identified in the stomach, the diagnosis is usually primary gastric carcinoma. In a recently published case study, both macroscopic and microscopic misdiagnosis were identified. Most melanoma deaths involve metastasis to other organs. Misdiagnosis of metastasis can lead to inappropriate treatment which can, in turn, increase the potential for adverse outcomes. These situations of misdiagnosis lead to increased burden on the health care system, loss of wages, unnecessary surgeries, and undue mental and emotional anguish.
In a published review article on studies related to malpractice claims, many studies pointed to physician training and experience as a cause of misdiagnosis. This review article also reported that the most common malpractice claims against pathologists were due to a false-negative diagnosis of melanoma. The authors did not find any cases of misdiagnosis due to laboratory error, follow-up, or patient-related delays. The article also cites a study conducted in Sweden, which estimated the rate of misdiagnosis to be 15% among dermatologists.
The lowest incidence of misdiagnosis occurred with dermatologists with greater than ten years of experience and exposure to more than ten melanomas annually. Accuracy in diagnosis undoubtedly increases with experience. So the study also found that physicians with less than one year of dermatologic experience were able to diagnose 31% of patients compared to 63% for physicians with more than ten years of experience.Sample Verdicts and Settlements
- 2018, Pennsylvania: $480,500 Verdict. Plaintiff sued defendant doctors claiming that they were negligent in failing to timely diagnose a non-healing ulcer on his right toe as skin cancer. As a result of the delay plaintiff alleged that his toe had to be amputated and his melanoma spread to his lungs. Defendants denied liability and claimed that plaintiff was at-fault because they referred him to specialists on several occasions and he never followed up. The jury found defendants 50% at fault and plaintiff 50% at fault and awarded $480,500 in damages.
- 2017, New Jersey: $900,000 Settlement. Plaintiff was a patient of defendant ophthalmologist for yearly eye exams and cataract issues. Defendant identified a non-malignant choroidal nevus (freckle on the eye). Plaintiff contended that the standard of care called for yearly inspection to ensure it did not become malignant.Yearly inspection was not regularly done and no analysis was done even when plaintiff started complaining of blurry vision, crusting and tearing in the eye. Eventually the freckle was discovered to be malignant and plaintiff was diagnosed with choroidal melanoma. Plaintiff sued the eye doctor claiming that was negligent and should have diagnosed the melanoma at least a year earlier. As a result of this delay in diagnosis, plaintiff claimed that eye-sparing therapies were no longer viable and he lost use of the eye. THe claim eventually settled for $900k.
- 2015, New York: $3,706,000 Verdict. A male is being deprived of a chance to cure or improve his melanoma, after a doctor at Columbia University College of Physicians and Surgeons interprets his biopsy as showing a non-cancerous mole, when in fact it is desmoplastic melanoma. He argues that the first biopsy done did show cancer and that the doctor failed to use the appropriate standard of care in failing to diagnose cancer. The jury awards him $3,706,000.
- 2014, Florida: $300,000 Settlement. A 66-year old male visits his doctor with a concern about skin changes. His doctor completes a report and notes squamous cell carcinoma, however, ten months later, a biopsy reveals malignant melanoma. He argues that the doctor was negligent by causing a delay in his cancer diagnosis, and the case settles at mediation for $300,000.
- 2013, Colorado: $9,329,600 Verdict. An adult female teacher notices a lesion on her left heel in January 2010, which ends up being melanoma that spreads to her lymph nodes in her pelvis and causes her death in July 2012. Her estate sues her primary care physician, for failing to biopsy the lesion, for failing to refer her to a specialist promptly, and for further failing to speak with her after her diagnosis and coordinate her care through the standard protocol. The doctor allowed the lesion to exist for over one year prior to having a biopsy ordered. The doctor and his employer, Kaiser Foundation Health Plan of Colorado, argue that the medical care she received was reasonable and that she failed to mitigate her injury. A jury agrees with the victim's family and awards $9,329,600.
- 2012, Iowa: $1,011,700 Verdict. A female suffers advancement of malignant melanoma due to her doctor failing to recommend a complete re-excision of a mole on her right arm that has regrown. The doctor does not identify the mole as malignant, does not advise the patient that it should be removed, and does not use proper care, failing to timely treat the malignant melanoma. She also claims that the doctor is wrongfully concealing information that previous biopsy’s from her arm do contain malignant melanoma. The jury awards her $1,011,700.
- June 2013, Colorado: $ 9,334,200 Verdict: A 66-year-old substitute teacher visited Kaiser Dermatology clinic with concerns of a facial lesion. The doctor only checks the upper half of her body and found nothing wrong. Two years later, she visited Kaiser Permanente’s after-hours clinic with concerns of a sore on her left heel that would not heal. They diagnosed her with cellulitis and prescribed her the antibiotic Keflex. Ten days later, she visited her primary care physician with the same concerns. The doctor gave her the same diagnosis and a prescription for Keflex. She returned the following month with the same complaints, and he once again gave her the same diagnosis and prescription. The woman spent the next five months carefully bandaging her heel and using antibiotic ointments to keep it from becoming infected. By the end of the fifth month, the sore had grown to double its size and was incredibly painful. Her physician referred her to the Kaiser Wound care department, but the woman still found herself visiting her physician weekly for six weeks before he referred her to the Kaiser Dermatology office. The referral was not expedited, and she was unable to get an appointment for two months. Before visiting the dermatology department, she returned to her physician and the wound care department claiming the wound was bleeding. The physician told her not to worry and did not document the complaint. When she was able to visit the dermatologist, the doctor’s assistant performed a shaved biopsy. It tested positive for melanoma. Further testing revealed that the melanoma was Stage 3 metastatic. She had to undergo a year and a half of debilitating and expensive treatments but unfortunately passed away from the melanoma. Her husband sued Kaiser Foundation Health Plan of Colorado and Colorado Permanente Medical Group for failing to check the lower half of the decedent’s body for skin cancer. He also sued her primary care physician for medical malpractice, claiming that he should have referred his wife for testing to determine the reasoning behind why a wound would not heal after three to six weeks. An oncology expert for the plaintiff testified that the melanoma was present during the initial body scan and would have been easily treatable had it been detected. Defendants denied all liability. An oncology expert for the defense testified that the decedent’s melanoma was rare and aggressive and was likely incurable at the time of her visit to the after-hours clinic. The matter carried on to the Denver County District Court where the jury found on behalf of the Plaintiff. They awarded the woman’s estate for $9,334,200.
- February 2012, New York: $ 15,000,000 Verdict: A 42-year-old homemaker visited a radiologist after she detected a mass in one of her breasts. A mammography was performed, and the radiologist determined that the size of the mass was not outside normal parameters and diagnosed the growth as a benign cyst. A follow-up examination was scheduled for the following year. Six months later, she was diagnosed with breast cancer after a physician discovered a tumor the size of a gold ball in the same breast. She had to undergo extensive and painful treatment, but unfortunately, the cancer spread to other areas of her body and her condition was considered terminal. The woman sued the radiologist for failing to diagnose her cancer, claiming the failure constituted medical malpractice. Plaintiff claimed that the radiologist did not fully investigate the nature of the mass and that a biopsy and sonogram should have been performed, which would have resulted in a diagnosis and prompt treatment. Defendant denied liability and claimed that he reasonably assumed the mass was a cyst, and the mammography’s results did not show a need for a biopsy or sonogram. After a twelve day trial, a jury found that the Defendant departed from the standard of care and awarded the Plaintiff $15,000,000.
- January 2012, South Carolina: $1,000,000 Settlement: A 28-year-old hairstylist visited her primary care physician with concerns about a mole on her left calf. The physician performed a punch biopsy and submitted it a pathologist. The pathologist determined that the mole was atypical and recommended to the physician that the mole should be re-excised. The woman was not informed of the recommendation. Four days later she returned to her physician and had the suture from the biopsy removed and bandaged. She was given no additional information nor was she referred to a specialist. Throughout the next year she visited the physician for unrelated reasons, but at no point did the physician re-examine the mole until she expressed concerns about changes that she had noticed. A second punch biopsy was performed, revealing the mole had progressed to Stage IIIB malignant melanoma. She was then referred to a dermatologist and oncologist who subsequently re-excised the mole but also needed to remove a portion of the woman’s calf. The woman sued her primary care physician for medical malpractice, claiming that he failed to inform her of the pathologist’s initial recommendation to have the mole re-excised and led to an untimely diagnosis and treatment. Plaintiff claimed that although her last two scans had been cancer-free, her oncologist believed that there was a 50% chance of cancer recurring and metastasizing within the next five years. The defendant denied liability but agreed to settle for $ 1 million.
- March 2012, Massachusetts: $ 650,000 Settlement: A 63-year-old woman visited a pathologist with concerns regarding a lesion on her big toe. The pathologist conducted a biopsy and diagnosed the lesion as blue nevus. The woman’s doctor noted that the lesion looked suspicious as possible melanoma and consulted with the pathologist. The pathologist informed the doctor that blue nevi tend to look like melanoma, but are generally benign and do not need to be excised. The woman returned a year later complaining of pains in the same toe. A podiatrist performed a second biopsy. She was ultimately diagnosed with acral lentiginous melanoma and unfortunately had to have her toe amputated. Fortunately, since the amputation, the melanoma has not returned. The woman sued the pathologist for medical malpractice, claiming that the Defendant should have identified the lesion as being malignant during the first biopsy. The defendant denied liability, arguing that he acted well within the standard of care. The parties agreed to settle before trial for $650,000.
- March 2008, Maryland: $5,805,000 Verdict: A 47-year-old lawyer visited his dermatologist for a routine checkup. During his visit, the dermatologist noticed a mole on his back that measured around 6 mm. He was recommended to visit his primary care physician to have the mole removed. At some point there was a miscommunication between physicians and both were under the impression that the other had removed the mole. About five years after his visit with the dermatologist, the man began to experience painful boils on his back. He visited a third physician who noted two cysts and an atypical mole that he recommended be removed. He was not informed of the condition of the mole 5 years back and concluded it was congenial and non-cancerous. At that time, the mole had grown to 1.3 cm; more than doubling its size. Two years later, after the man’s wife noticed that the mole had changed color, he finally had it removed. Unfortunately, shortly after that, he was diagnosed with skin cancer that had spread to the lymph node, and he died the following year. His estate sued all three physicians for medical malpractice. Plaintiff alleged that the third physician was negligent in not recommending removal of the large mole. An expert for the Plaintiff opined that had the mole been removed during the decedent’s first visits, he would have had a 95% chance of survival. All three defendants denied negligence. A Montgomery County jury found for the plaintiff and awarded a $5,805,000 verdict.
If you live in the Baltimore-Washington area and believe you or a loved one have been a victim of medical negligence, call 800-553-8082 or get a free online medical malpractice consultation.