Squamous Cell Carcinoma (SCC) of the skin is one of the most common forms of skin cancer, and often very treatable. But when doctors overlook high-risk warning signs or fail to share critical information with patients, the consequences can be life-altering. Aggressive SCC can spread quickly, causing devastating injury, disfigurement, or worse.
At Bell Law Firm, we’ve seen how delayed diagnoses and missed follow-up care can rob patients of the chance for effective treatment. Here’s what families need to know about high-risk SCC, why timing is everything, and the importance of full transparency in care.
Understanding the Hidden Danger of High-Risk SCC
SCC becomes especially dangerous in sensitive areas like the head and neck because it actively destroys local tissues. It “eats” into local structures rather than simply pushing them aside, a characteristic that can lead to catastrophic injury and severe disfigurement if not aggressively managed.
Several factors significantly heighten the risk of aggressive behavior and recurrence in SCC:
- Perineural Invasion (PNI): PNI is the finding of cancer cells invading the nerves. This is a high-risk feature that allows cancer cells to travel along the nerve sheath, often serving as a pathway for cancer to skip beneath surgical margins and spread deeper. PNI signals that the tumor will behave aggressively.
- Immunosuppression: Patients who are immunocompromised (such as those with a history of Non-Hodgkin’s lymphoma or Chronic Myeloid Leukemia) are considered high risk for developing SCC and experiencing aggressive recurrence.
- Tumor Size and Location: Large tumors (greater than 2.0 cm) and location in high-risk zones like the preauricular area (in front of the ear) further compound the danger.
In a high-risk patient with both immunosuppression and PNI, the tumor is particularly dangerous.
Why Early Diagnosis and Action Matter
For high-risk cancers, timing is critical. Two key steps often define the difference between effective treatment and missed opportunity:
- Mandatory Pathological Review: Physicians must send excised tissue for pathological evaluation when they surgically remove a suspicious lesion, even if they suspect it is benign, like a cyst. Failure to send off excised tissue for biopsy constitutes a violation of the standard of care.
- Prompt Referral to Radiation Oncology: If PNI is identified, especially in an immunocompromised patient, the Mohs surgeon is required by the standard of care to recommend consultation or referral to a Radiation Oncologist. Doctors recognize radiation therapy as highly effective for destroying cancer cells that travel down nerve tunnels.
Delays in either step can allow cancer to spread, drastically reducing treatment options.
Patients Deserve Full Transparency
The cornerstone of quality care is the patient’s right to complete and relevant information necessary to make informed healthcare decisions.
The discovery of a high-risk feature like PNI during initial surgery fundamentally changes the patient’s prognosis and requires follow-up. The Mohs physician must discuss this feature with the patient and recommend the necessary consultation to meet the standard of care.
The failure to communicate the findings of PNI and the subsequent failure to refer the patient for radiation oncology consultation prevent the patient from understanding their increased risk of recurrence and seeking appropriate adjuvant therapy. When doctors keep high-risk patients ‘in the dark about their condition,’ they face especially dangerous consequences.
When medical professionals fail in their fundamental duty to provide competent care, inform patients of critical findings, or release accurate records, the consequences can be life-altering and devastating.
If you or a loved one has suffered harm due to medical negligence, delayed diagnosis, or inadequate disclosure of critical medical information. In that case, you need a powerful legal advocate to fight for your rights. Contact the Bell Law Firm today to discuss your case.