Koleno v. Dermatologist

  • Circuit Court of Cook County (Judge Elizabeth Budzinski)03/14/2010
    Client: Defendant Dermatologist
    Outcome: Defense Verdict

Synopsis:

Plaintiff presented to the defendant dermatologist’s office on October 4, 2001 for an evaluation of a non-healing sore on his right lower lip.

The defendant could not make a clinical diagnosis of the sore so he obtained a biopsy and asked a dermatopathologist to rule out squamos cell carcinoma. The dermatopathologist reviewed the biopsy specimen but he was not able to make a specific diagnosis. In his report to the defendant, the dermatopathologist stated that he could not rule out early squamous cell carcinoma and he recommended that the entire lesion be excised. The defendant decided to monitor the lesion and did not perform an excision or re-biopsy at that time.

The area healed, but the plaintiff returned six months later with a recurrent sore in the same area. The defendant then obtained a second biopsy. This time the dermatopathologist stated that there was no evidence of cancer. The defendant, therefore, decided to continue to monitor the lesion. Defendant last saw the patient on July 16, 2002.

Defendant then sought a second opinion about seven months later from a second dermatologist. The second dermatologist thought that the patient's sore on his right lower lip was a pre-cancerous condition and he, therefore, performed a laser procedure to vaporize the pre-cancerous cells. Plaintiff continued to have problems with his lower lip and returned to see the second dermatologist in September 2003 when a third biopsy was done showing the presence of squamous cell carcinoma, Stage I. A complete surgical excision was performed in October 2003.

Unfortunately, the disease could not be controlled and continued to spread. Plaintiff had another surgery in November 2004 where essentially a large portion of his mandible was removed. He required feeding tubes and was debilitated, quite sick and suffered many complications from the chemotherapy and radiation. He passed away on February 26, 2005, survived by his wife of 36 years, and four adult children.

Plaintiff's experts criticized the defendant for failing to diagnose plaintiff’s lower lip condition as pre-cancerous based on the biopsy reports and also criticized defendant for failing to follow the recommendation of the pathologist for a total excision at which time the process could have been cured and plaintiff would not have gone on to develop invasive squamous cell carcinoma.

The defense argued that the defendant’s treatment was reasonable and that there was no histologic evidence of pre-cancerous cells or cancerous cells. The defense argued that it did not make sense to completely excise this lesion when the dermatopathologist did not diagnose it as either cancer or even pre-cancer.