Doctor said he could 'feel' no tumour

A CONSULTANT dermatologist accused of failing to adequately treat a skin cancer patient, was able to “feel” by touching that there was no tumour tissue, a fitness-to-practise hearing was told by his lawyer yesterday.

Dr Adam Jacobus Smith faces more than 120 allegations of professional misconduct or poor professional performance. He denies a number of allegations.

All 12 patients involved were treated by Dr Smith, of the Whitfield Clinic in Waterford, between 2006 and 2009. The inquiry was heard on several dates earlier this year and resumed yesterday.

Among the allegations regarding his professional performance, Dr Smith is accused of failing to refer a skin cancer patient to a plastic surgeon for a “wide excision” .

Dr Smith carried out an excision of a lesion on the leg of the woman in her 70s (patient G).

However, a wide excision was needed to “reduce the risk” of recurrence and regional spread, Michael O’Shaughnessy of Cork University Hospital said yesterday.

Mr O’Shaughnessy ultimately carried out the wide excision on patient G after she was referred to him by a second dermatologist.

The second dermatologist had been concerned about the case as a histology report showed she had “poorly differentiated squamous cell carcinoma” on her leg, the inquiry heard last month.

Dr Smith will tell the Medical Council inquiry that when carrying out the original excision on patient G he was able to feel underneath that there was no tumour, his counsel Gabriel Gavigan said yesterday. Dr Smith did not give evidence during yesterday’s public sitting.

However, Mr O’Shaughnessy said there needed to be a distinction between the macroscopic (what is seen with naked eye) and the microscopic. If Dr Smith had “microscopic vision” that’s “impressive” he said.

Mr O’Shaughnessy said, under cross-examination, that there was no cancer remaining in patient G’s leg after Dr Smith finished his excision of the lesion.

However, the only reason it was known that the area was free of cancer was because the surgeon had later carried out a wide excision, he said. A wide excision with a carcinoma was “standard practice” because it was “well recognised” that such a lesion was much more likely to have local recurrence and regional spread, Mr O’Shaughnessy said.

The inquiry also heard from Dr Colin Buckley, consultant dermatologist who treated Dr Smith’s former patient, patient L.

Patient L is a 67-year-old disabled woman with rare autoimmune disease pemphigus vulgaris. However, Dr Smith diagnosed and treated patient L for psoriasis, the inquiry heard.

She later developed “golf-ball-sized blisters” and was diagnosed in hospital with pemphigus vulgaris, a sitting of the inquiry last month had heard.

Dr Smith will give evidence that he examined patient L’s arms, legs, chest, back and scalp, Mr Gavigan said as he cross-examined Dr Buckley.

If that were the extent of the examination “he would have seen a condition other than psoriasis”, Dr Buckley said. He said that for a dermatologist the appearance of psoriasis was quite different from pemphigus vulgaris.

Mr Gavigan said that Dr Buckley gave evidence at an earlier sitting of the inquiry that pemphigus vulgaris had a “psoriasis-like” appearance.

He argued that there may not have been blisters on the patient’s skin when she saw Dr Smith.

The hearing continues today.