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Dermatology (Expert Forum)
Diagnosing Squamous Cell
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
Diagnosing Squamous Cell
by tomi, Apr 02, 2004 12:00AM
My 43 y.o. husband had a growth on his forehead removed. He noticed it and within a week was at the doctor.
The dermatologist, who reads his own slides, made a diagnosis of Squamous Cell carcinoma. They informed us of the diagnosis at 4:30 on Monday and said he must come in for Mohs surgery at 2:00 on Tuesday. We went in asking questions which he would not answer. He would not provide his biopsy report nor give us any details about how he made his diagnosis other to say that this was in the very earliest stage and that "any gorilla with some bananas could make the diagnosis of scc, it is that straightforward".
He also would not discuss any other option other than Mohs and then told us we are making a big deal out of nothing.
Needless to say we left his office seeking a second opinion.
What can a skilled reader of a biopsy slide determine? Can they tell how advanced, if it is well-differentiated, the depth, the "stage or grade"?(this was a shave biopsy)
Is it common for the dermatologist to read his own slides?
Is it common to misdiagnose SCC?
How aggressive is SCC and did we jeapordize my husband's health by not having it removed immediately? It will be 2-4 weeks before the specialist we have chosen can get him in for surgery if the second opinion agrees with the SCC diagnosis.
Is my husband now at greater risk for SCC having had one growth?
Is he at greater risk for Basal Cell? Malignant Melanoma?
What about a greater risk for non-skin cancers in the future?
I have read that SCC can metastasize. Is that a real concern, even if the doctor said it was in the "earliest stages"?
Anything you can share would be helpful.\
Thanks
The dermatologist, who reads his own slides, made a diagnosis of Squamous Cell carcinoma. They informed us of the diagnosis at 4:30 on Monday and said he must come in for Mohs surgery at 2:00 on Tuesday. We went in asking questions which he would not answer. He would not provide his biopsy report nor give us any details about how he made his diagnosis other to say that this was in the very earliest stage and that "any gorilla with some bananas could make the diagnosis of scc, it is that straightforward".
He also would not discuss any other option other than Mohs and then told us we are making a big deal out of nothing.
Needless to say we left his office seeking a second opinion.
What can a skilled reader of a biopsy slide determine? Can they tell how advanced, if it is well-differentiated, the depth, the "stage or grade"?(this was a shave biopsy)
Is it common for the dermatologist to read his own slides?
Is it common to misdiagnose SCC?
How aggressive is SCC and did we jeapordize my husband's health by not having it removed immediately? It will be 2-4 weeks before the specialist we have chosen can get him in for surgery if the second opinion agrees with the SCC diagnosis.
Is my husband now at greater risk for SCC having had one growth?
Is he at greater risk for Basal Cell? Malignant Melanoma?
What about a greater risk for non-skin cancers in the future?
I have read that SCC can metastasize. Is that a real concern, even if the doctor said it was in the "earliest stages"?
Anything you can share would be helpful.\
Thanks
Doctor's Answer
by Alan Rockoff, MD, Apr 02, 2004 12:00AM
, Apr 02, 2004 12:00AM
It sounds as though what your dermatologist did and said was quite reasonable, though his method of presenting it left you with doubts. Some dermatologists are indeed skilled at reading their own slides. Squamous cell cancers of the skin are not high risks for metastasis. The risk for other basal or squamous cell cancers is raised, but not that much. Regular surveillance and prudent sun protection should suffice. Melanoma risk is not appreciably raised, though skin surveillance for that too is recommended. There is no great urgency here--the time frame for getting a second opinion and subsequent surgery if needed is fine.
Best.
Dr. Rockoff
Best.
Dr. Rockoff
We have yet to determine if this was intentional on the part of the dermatologist who made the misdiagnosis but it should stand as a reminder to anyone diagnosed with cancer to seek a second or third opinion, even on skin cancer.