Playing Defense: Basic Training for Patients

DEFENSIVE MEDICINE CASE STUDIES FROM THE TROPICANA MEDICAL SCHOOL FOR PATIENTS—-ON LINE CAMPUS 

By Paul Goldfinger, MD, FACC

TMS  Case #2:  A sixty five year old man went to his dermatologist last year. He showed the doctor a dark brown spot on his arm which was the size of a dull pencil point.  The patient was worried about it. The doctor looked at it and said, “It’s nothing.”

The next year the man returned for his annual skin surveillance exam.  The spot had gotten to be much darker.  He told the doctor that he was worried about it and he wanted it removed.  The doctor said, “It’s nothing, but because you are so worried, I will remove it.”  He took a dime sized biopsy and sent it to the lab.

Five days later, the doctor called, somewhat chagrined, and said that there was a skin cancer:  an “in situ melanoma.”  This means that it was not too deep and could probably be cured with surgery.    The dermatologist then made a two inch incision producing wide margins around the spot.  The lab reported that all margins were clear of cancer.

Analysis:  The dermatologist made an error—one that should not have been made by a board certified specialist.  Melanoma is the most serious kind of skin cancer and can cause death. The patient helped save himself.

Lesson:  The classic signs of a melanoma are dark spots, perhaps getting darker or bigger, irregularity around the margins, color changes, and raised bumps.  A major causative  factor is sun injury early in life.  If you have any lesions like that, insist that they be removed, even if the doctor disagrees.

Check your skin regularly and see a dermatologist once per year.   Protect your skin with hats, sunblock over spf 30–apply every 2 hours, and stay in the shade between 10 a.m. and 4 p.m.   Patients must be vigilant and assertive as they practice defensive medicine.

Check this slide show from the Mayo Clinic:   Mayo Clinic slide show about melanoma