What Is Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is the most common type of skin cancer. In this article, we’ll explain what basal cell carcinoma is, describe the stages of the disease, risk factors, symptoms, and how delays in diagnosis and treatment can lead to significant harm. We will also discuss when delayed diagnosis and treatment of cancer may be due to medical malpractice and what steps to take if you believe you or a loved one has suffered from such delays.
BCC develops in the basal cells, which make up the outer layer of the skin (epidermis). While it usually grows slowly and is not life-threatening, untreated BCC can damage surrounding tissues and, in rare cases, spread to other parts of the body.
Basal cell carcinoma occurs when the DNA in skin cells gets damaged, leading to uncontrolled cell growth. This type of cancer often appears on areas exposed to the sun, such as the face, neck, and arms. It can show up as a shiny or pearly bump, a flat patch of skin that looks like a scar, or an open sore that doesn’t heal properly. Though BCC rarely spreads to other organs, it can grow deeper into tissues, causing significant damage.
What Are the Stages of Basal Cell Carcinoma?
Basal cell carcinoma is divided into these stages:
- Stage 0 (Carcinoma in situ): Abnormal cells are present but have not spread beyond the top layer of skin.
- Stage 1: The tumor is 2 centimeters or smaller and hasn’t spread to nearby lymph nodes or tissues.
- Stage 2: The tumor is larger than 2 centimeters or has certain high-risk features, like aggressive growth.
- Stage 3: The cancer has spread to nearby bones or tissues.
- Stage 4: The cancer has spread to distant organs or lymph nodes.
How Common Is Basal Cell Carcinoma, and Who Is Most at Risk?
BCC is the most frequently diagnosed type of cancer in the U.S., with more than 3.6 million cases each year. It is most common in people with fair skin, especially those who have spent significant time in the sun or used tanning beds. Older adults and people with weakened immune systems are also at higher risk.
Risk Factors for Basal Cell Carcinoma
Several factors increase the risk of developing BCC:
- Prolonged exposure to UV radiation from the sun or tanning beds
- Having fair skin, light eyes, or blond or red hair
- A personal or family history of skin cancer
- Older age
- A weakened immune system
- Exposure to radiation or toxic chemicals
Signs and Symptoms of Basal Cell Carcinoma
Patients and doctors should watch for the following signs of BCC:
- Shiny, pearly bumps with visible blood vessels
- Flat, scaly patches that may resemble eczema
- Open sores that bleed, scab over, and fail to heal
- Waxy, scar-like lesions
Screening Guidelines for Basal Cell Carcinoma
Early detection is critical for successful treatment. High-risk individuals should:
- Schedule annual skin exams with a dermatologist.
- Perform regular self-checks for new or changing skin spots.
- Use mobile apps to monitor changes in moles or lesions.
- Seek medical advice promptly for suspicious lesions.
Diagnostic Testing Guidelines Following an Abnormal Screening
If a suspicious spot is found, doctors typically follow these steps:
- Skin Biopsy: A sample of the lesion is taken and examined under a microscope to confirm cancer.
- Dermoscopic Examination: A dermatologist uses a dermatoscope to get a detailed look at the lesion.
- Pathology Review: A pathologist analyzes the biopsy to determine the type and aggressiveness of the cancer.
- Imaging Tests: Advanced imaging, such as MRI or CT scans, may be used if the cancer is suspected to have spread.
Steps in Diagnosing Basal Cell Carcinoma
The process of diagnosing BCC typically involves:
- A visual examination by a dermatologist to spot abnormal growths.
- Dermoscopy to get a close-up view of suspicious lesions.
- A biopsy to confirm the presence of cancer and its type.
Impact of Delayed Diagnosis of Basal Cell Carcinoma
Delays in diagnosing basal cell carcinoma (BCC), the most common form of skin cancer, can lead to a range of serious consequences that affect a patient’s physical health, emotional well-being, and financial stability. While BCC typically grows slowly and is highly treatable when caught early, delayed detection can allow the cancer to progress, resulting in significant complications.
Physical Health Consequences of Basal Cell Carcinoma
- Larger, More Aggressive Tumors:
- When BCC is not diagnosed and treated promptly, the tumor may grow larger and invade deeper layers of the skin and surrounding tissues. This can make treatment more complex and less effective, particularly if the cancer extends into muscles, bones, or cartilage.
- Invasive Treatment Requirements:
- Delays in diagnosis often necessitate more invasive medical interventions, such as Mohs surgery, wide local excision, or reconstructive surgery. In some cases, advanced tumors may require radiation therapy or systemic treatments, which are typically unnecessary for early-stage BCC.
- Disfigurement and Loss of Function:
- Tumors that grow unchecked, particularly in sensitive areas like the face, neck, or hands, can cause significant disfigurement. Surgical removal of large or invasive tumors may result in permanent scarring or functional impairments, such as difficulty moving affected areas or loss of sensory functions.
- Rare but Serious Metastasis:
- Although metastasis is uncommon in BCC, advanced cases that remain untreated can spread to lymph nodes, bones, or other organs. This transformation into metastatic BCC is life-threatening and requires aggressive, high-risk treatments.
Emotional and Psychological Impact of Basal Cell Carcinoma
- Emotional Distress:
- Learning that a delay in diagnosis has allowed cancer to progress can lead to feelings of anger, frustration, and fear. Patients may struggle with the knowledge that earlier intervention could have prevented more severe outcomes.
- Anxiety About Future Health:
- Patients with advanced BCC often experience heightened anxiety about potential recurrences, additional treatments, or long-term effects of the disease and its treatment.
- Impact on Self-Image:
- Disfigurement or visible scarring caused by delayed diagnosis and treatment can significantly impact a patient’s self-esteem and quality of life. This is particularly true for tumors located in prominent areas, such as the face.
Financial Strain
- Higher Medical Costs:
- Advanced treatments for delayed BCC diagnoses, such as complex surgeries, reconstructive procedures, or systemic therapies, are often significantly more expensive than early-stage treatments like minor excisions.
- Loss of Income:
- Prolonged treatment and recovery times may result in missed work or lost earning potential, adding to the financial burden for patients and their families.
Social and Family Dynamics
- Stress on Family Members:
- The uncertainty and demands of managing advanced BCC can strain relationships and place emotional and financial pressure on loved ones.
- Caregiver Burden:
- Family members may need to provide care during recovery from surgeries or treatments, which can disrupt their daily lives and contribute to stress.
Preventive Measures and Advocacy
To mitigate the risks associated with delayed diagnosis, healthcare providers must adhere to established protocols for evaluating and managing suspicious lesions. Regular skin examinations, timely referrals to specialists, and clear communication with patients about biopsy results are critical to preventing advanced disease. When these standards are not met, patients may have grounds to pursue legal action to seek accountability and compensation for the harm caused by delayed care.
Treatment for Basal Cell Carcinoma
Treatment depends on the tumor’s size, location, and stage. Common options include:
- Surgical Removal: Excisional surgery or Mohs surgery to remove cancerous tissue.
- Radiation Therapy: For cases where surgery isn’t possible.
- Topical Medications: Creams like Imiquimod or fluorouracil for superficial BCC.
- Targeted Therapy: Drugs like Vismodegib for advanced or recurrent cases.
When Is a Delay in Diagnosis and Treatment Due to Medical Malpractice?
A delay in diagnosing and treating basal cell carcinoma (BCC) may qualify as medical malpractice when it results from a healthcare provider’s failure to adhere to accepted standards of care. The standard of care refers to the level of skill, attention, and diligence that a reasonably competent healthcare professional would exercise under similar circumstances. When a healthcare provider deviates from this standard, leading to a delay that allows BCC to progress and cause harm, it may constitute negligence and warrant legal action.
Common Scenarios of Negligence Leading to Malpractice
- Failure to Recognize Suspicious Skin Changes:
- Healthcare providers are expected to identify signs of BCC, such as non-healing sores, raised lesions, or scaly patches. Overlooking these indicators during routine exams or consultations can allow the cancer to grow unchecked.
- Failure to Perform a Biopsy When Medically Necessary:
- A biopsy is the gold standard for diagnosing skin cancer. Failing to recommend or perform one when a lesion exhibits suspicious characteristics is a significant deviation from the standard of care.
- Ignoring Standard Screening Guidelines:
- For patients at higher risk of skin cancer (e.g., those with a history of sun exposure, fair skin, or previous skin cancers), providers should adhere to established screening protocols. Neglecting these guidelines can delay early detection.
- Dismissing a Lesion as Harmless:
- General practitioners or dermatologists may mischaracterize a concerning lesion as benign without further investigation, delaying necessary diagnostic tests or referrals.
- Errors in Pathology or Lab Procedures:
- Biopsy samples that are lost, misinterpreted, or mislabeled can significantly delay diagnosis, resulting in the cancer advancing to a more severe stage.
- Failure to Follow Up:
- Physicians must ensure patients receive timely results from tests and procedures. Delays in communicating biopsy findings or scheduling follow-ups can hinder prompt treatment.
Consequences of Delayed Diagnosis of Basal Cell Carcinoma
When a delay in diagnosing and treating BCC occurs due to medical negligence, the consequences for patients can be severe:
- Advanced Tumor Growth: The cancer may invade deeper tissues, requiring more aggressive treatments.
- Disfigurement: Surgical procedures to remove advanced BCC can result in significant scarring or loss of function, particularly in sensitive areas like the face.
- Nerve Damage or Loss of Function: In cases where BCC invades underlying structures, patients may suffer permanent damage.
- Increased Costs: Delays often lead to more extensive and expensive medical interventions.
- Emotional Distress: Patients and their families endure added stress and anxiety from living with an advanced diagnosis and the challenges of treatment.
Identifying Medical Malpractice
Determining whether a delay in diagnosing BCC constitutes malpractice often requires:
- Thorough Review of Medical Records: A detailed analysis of the patient’s medical history, including missed opportunities for diagnosis or treatment.
- Expert Evaluation: Testimony from dermatologists, pathologists, or other relevant specialists to assess whether the standard of care was breached.
- Evidence of Harm: Demonstrating that the delay directly caused the patient harm, such as progression to a more severe stage or the need for more invasive treatments.
Examples of Lawsuit Settlements or Verdicts Related to Basal Cell Carcinoma
Delays in diagnosing and treating basal cell carcinoma (BCC) can lead to severe health complications, often resulting in significant legal settlements and verdicts. Here are detailed examples illustrating the consequences of such delays:
New York: $350,000 Settlement for Failure to Diagnose Skin Cancer
A woman received incorrect biopsy results from her Brooklyn dermatologist, who informed her that a mole on her forehead was benign. As the mole began to grow rapidly, she sought a second opinion and was correctly diagnosed with basal cell carcinoma. Although the cancer had not metastasized and was successfully removed via Mohs surgery, the procedure left noticeable scars on her forehead. The patient argued that immediate diagnosis and removal would have prevented the scarring. The case was settled for $350,000.
California: $2.5 Million Settlement for Delayed Cancer Diagnosis
Linda, a patient in California, consulted a specialist who failed to recognize obvious signs of basal cell carcinoma on her face and did not order a biopsy. By the time the cancer was correctly diagnosed, it had deeply infiltrated her cheek and nose, necessitating extensive surgery that resulted in facial disfigurement and required reconstructive procedures. Linda pursued legal action and received a $2.5 million settlement for the suffering caused by the delayed diagnosis.
South Carolina: $453,919 Verdict for Misdiagnosed Basal Cell Carcinoma
In 2018, a patient presented with a nasal lesion, which a dermatologist misdiagnosed as benign after a biopsy. The lesion persisted, and a subsequent biopsy in 2020 revealed it was basal cell carcinoma. The delay in accurate diagnosis led to more invasive treatment. The patient filed a malpractice lawsuit, resulting in a jury awarding $453,919.47 in damages.
Massachusetts: $1 Million Settlement for Delayed Melanoma Diagnosis
A 55-year-old man with a history of multiple basal cell carcinomas underwent routine skin evaluations. In August 2001, a dermatologist excised a suspicious nodule from his back but failed to diagnose malignant melanoma promptly. The delay in diagnosis led to the patient’s death. His family pursued a wrongful death lawsuit, resulting in a $1 million settlement.
These cases underscore the critical importance of timely and accurate diagnosis of basal cell carcinoma. Delays can lead to more invasive treatments, significant disfigurement, emotional distress, and substantial financial burdens. Healthcare providers must adhere to standard care protocols to ensure early detection and treatment, thereby preventing the severe consequences associated with delayed diagnosis.
How Lupetin & Unatin Can Help
If you believe a delayed diagnosis of BCC has caused harm, contact the Pittsburgh medical malpractice attorneys of Lupetin & Unatin. We have extensive experience handling cases related to skin cancer misdiagnosis, including Basal Cell Carcinoma. We are dedicated to holding healthcare providers accountable for medical negligence. Please contact us for a free case evaluation.