- What is the diagnosis?
This is a basal cell carcinoma (BCC). This skin malignancy and squamous cell carcinoma are the most common forms of skin cancer.
- What patterns of growth can be seen with this lesion?
These neoplasms grow slowly but persistently. Most often they are unifocal, but sometimes they can be multifocal.
- What is the prognosis?
Basal cell carcinoma has a cure rate of nearly 100% with surgical excision, because the lesions are slow-growing and remain localized for so long. Most squamaous cell carcinomas are detected early and can be cured with surgical excision. However, skin cancers are malignant and will continue to grow and infiltrate, so have the potential to become serious. Lesions on the face can involve critical structures such as eyelids and require careful plastic surgical repair. Skin cancer is, in fact, the most common type of cancer in light-skinned persons, but it does not appear on charts listing cancer rates and cancer deaths because it is so curable. Melanomas, though far less frequent than squamous cell or basal cell carcinomas, are not indolent and can kill the patient in many cases.
- Worst case scenario: what would you do if the patient had seen another physician who did not properly treat a basal cell carcinoma of the eyelid, and now the patient may lose the eye?
Negligence requires not just a mistake, but a mistake that should not have happened, i.e. sub-par treatment or failure to meet the 'standard of care' AND that some harm resulted from the mistake. It is not easy to prove, since the course of disease is variable, as well as treatment outcomes. Thus when it does happen (i.e., someone is charged with it) it is probably best to not to express an opinion unless you know all the details.
If this is a true case of negligence, you should empathize with the patient, not the doctor who made the mistake. You should consider telling the patient to get legal counsel, if the patient hasn't already done so, and offer to act as an expert witness if necessary. You should consider reporting the case to the governing body for medical licensure. Hiding the truth will make you suspect as well.
Don't fall into the trap of reflexly blaming those in the legal profession for problems in medical practice. All too often people who are guilty of something want to put the blame elsewhere. It is a classic defense mechanism. From large scale studies of adverse patient outcomes, it is found that only about 10% of all cases involving some degree of negligence go to litigation.
A good doctor cares about his patients, and ethics puts the patient's best interests above one's own and that of other doctors.
