Failure to Diagnose Oral Cancer

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Michael E. Pliskin, DDS, Ph.D. ::::

Case Synopsis: A 62 year-old Caucasian male noticed a small “sore” on the undersurface of his tongue. His physician referred him to an oral surgeon who biopsied the lesion. The pathological diagnosis was an invasive squamous cell carcinoma. Additionally, the patient also had clinically palpable neck masses which suggested that the cancer had spread from his tongue to the draining lymph nodes. Treatment consisted of surgical removal of half his tongue and a radical neck dissection followed by radiation treatment. The patient had been examined by his general dentist eight months before the discovery of the cancer. Consequently, he filed suit against the general dentist for failing to diagnose the tumor.

Expert Analysis: The cancer at the time of diagnosis was 2.4 cm. at its largest diameter. The question was whether the tumor was of detectable size eight months earlier when he had been examined by his general dentist. The scientific literature on the kinetics of tumor growth revealed that squamous cell carcinomas are some of the more rapidly dividing cancer cells, with doubling times ranging from 45-78 days. Utilizing this data, a 2.4 cm. tumor would have been below the detectable size of 0.2 cm. when the patient had been examined by his dentist eight months earlier. The cancer was not clinically detectable when the general dentist examined the patient.

Conclusion: Jury found in favor of the dentist. This study demonstrated how the use of basic science information can be applied to a clinical situation.

 

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