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Misdiagnosis of Melanoma

Melanoma is a form of skin cancer.  If not diagnosed and treated promptly, it can be fatal.  There are a series of features of a lesion/mole that are suspicious for melanoma, which might prompt general practitioners to make a referral to a specialist, such as follows [1]:

1. A history of change in size of the lesion (clearly, no GP would be able to see this – s/he must ensure that this is checked back with the patient);
2. Irregularity of shape;
3. Irregularity of colour;
4. Largest diameter 7mm or more;
5. Inflammation;
6. Oozing;
7. Change in sensation.

NICE GUIDANCE

Under NICE (National Institute for Health and Care Excellence) Guidance of June 2005, a scoring system is operated in relation to these features. In essence, the higher the score, the more compelling the case is for prompt referral to a specialist.

Patients are generally referred to dermatology in the first instance, and usually an excision of the suspicious tissue occurs.

A biopsy is then performed upon the tissue, with the aim of determining whether or not the lesion is cancerous.  If it is, then further treatment may be required, usually involving the local oncology service.   The type of treatment required depends upon where the lesion is, its staging, and whether it has metastasised.

THE IMPORTANCE OF PROMPT DIAGNOSIS

As with any cancer, the longer it is left, the harder it is to treat melanoma successfully: consequently, the more likely it is that the patient will have a poor outcome.  Sadly, such outcomes can involve early death, or at the very least an increased risk of early death.

Unfortunately, failure to diagnose melanoma or misdiagnosis of melanoma is not an uncommon issue in medical negligence cases.   Recently, articles in the medical literature have been published that have identified this as a point of concern in primary care (i.e., in care involving GPs).

MEDICAL NEGLIGENCE CASES INVOLVING MISDIAGNOSIS OF MELANOMA

As in any clinical negligence claim, your solicitor will need to determine whether the treatment – whether provided by the GP or any other professional involved – was so bad as to be negligent.  This is done by reference to the standards of the day.  Therefore, if at some point after 2005 (when the above NICE Guidelines came into force), a GP saw a patient who complained about a lesion/mole with some or all of the features listed above, and did not make a referral, then they may face some serious questions about whether their treatment was of an acceptable standard.  As in all medical negligence cases, we need to judge “like with like” – so a claim arising from alleged GP negligence would have to be investigated by reference to a GP and what was considered acceptable treatment in the circumstances.

In clinical negligence cases claimants also have to show that as a consequence of that negligence, harm occurred that would otherwise have been avoided.   For this reason, it is probable that your solicitor would wish to seek the advice of an oncologist.  The remit of the oncologist would be to determine (a) whether the patient’s condition and clinical course has been affected by the treatment received, and/or (b) whether as a result of that treatment, the patient required care and medical procedures that otherwise they would not have needed.

Because of the complexities of the law and the medicine in cancer cases, it is vital that if you have such a case, you seek legal advice from a suitably specialised firm, such as the Clinical Negligence Team, to ensure the treatment is fully investigated and the best experts are instructed to ensure the best outcome to the case.  If you have any concerns please contact me or one of my colleagues.

My colleagues and I have investigated a number of cases involving misdiagnosis of melanoma, often involving GPs in recent years.  As the literature has pointed out that this is an area for concern it seems that further reviews and training is required to ensure prompt diagnosis and the best outcome for the patient.

[1] This should not be constituted as medical advice or an exhaustive list of symptoms.  Any concerns should be addressed to a qualified medical practitioner.

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