Please help. Just found this on my dad's back.

[sprigatito]

My dad's partner died of cancer a few days ago, he and I were with her when she died, and I've brought him home with me until the funeral (and probably permanently). He's got Alzheimer's and his partner was his carer. He's been looking pained and twisting his shoulder, he said it's just a spot, but I made him show me his back and found this. It looks just like the squamous cell carcinoma he's had removed before, only it's enormous. He's lost weight and is pale and more vague and breathless than usual, but I thought it was just grief

This is really fucking bad, isn't it? He survived stage 4 lymphoma in 2017 and has a heart condition. I have a doctor calling me back from 111, but should I just take him to A&E?

Jeez...not the issue here guys!

Well that is your hospital. It isn’t mine.

Again...not really relevant! Rein it in!

It is relevant. I’m saying that having bloods at the outpatients appointment doesn’t mean a long wait. I was trying reassure the OP.

If they had felt that your dad's case exceeded their level of competency they would have called a GP.

In principle, in practice, I don’t know about ANPs but the PAs at our practice don’t call doctors when they’re out of their depth. My mother’s first attempt to get her skin diagnosed - the PA thought it was sunburn in December. She did not call a doctor. I told my mother to insist on an appt with a doctor. It turned out to be Sézary syndrome, which is a T-cell lymphoma.

Absolutely true. Let’s focus on OP.

But they have referred him on which is just what the GP would have done anyway, isn't it?

To be honest I’m under dermatology and my GP often completely steps back and lets my dermatologist advise.

For example an occasion where I haven’t seen my dermatologist in 6 months and saw my GP. My GP explained they don’t have as much insight in skin conditions and they wouldn’t want to guess or give me even standard treatment without referring to my dermatologist first. So this means that often they email my dermatologist to double check or to book an appointment instead of using their own judgement even though I wasn’t under frequent observation of my dermatologist. Plus this was a non-urgent issue where using standard treatment would be low risk in comparison to your father.

So I therefore am not sure if seeing a doctor would have given you any more insight into what’s going on, based on my experience. I don’t think a doctor would necessarily have alleviated your concerns any more than the nurse has. It took me a few wrong diagnoses before the dermatologist gave me the right one.

In this case yes.

A 2 week referral sounds positive, and I would imagine that the GP would have done the same. It can be complex prescribing for someone with dementia - could you contact his regular GP and explain the situation? They may be happy to send a prescription to your GP given they have access to his full medical notes?

Reading this really brought a tear to my eye.
im so sorry this is happening to you all.

dementia is absolutely awful.

Oh gosh your poor dad.

As others have said, the two weeks is a maximum and they're very likely to see him much sooner.

Each day is agony when you're in the unknown through isn't it

Showed DH your picture. He's a dermatologist. He thinks needs biopsy urgently. Nurse practitioner made the right decision for 2 week wait referral.

The dermatologist will get to the bottom of the skin lesion - however if you think your father also needs painkillers please ring back the GP to make an appointment to discuss. Also if he has new worsening shortness of breath consider asking for a chest X-ray or chest assessment +/- bloods. These are not necessarily things that will be addressed on the day with the dermatologist. The nurse has referred appropriately for the skin but I’d consider if your Dad needs some analgesia and further investigations of the shortness of breath alongside dermatology review n

@2Old2Tango can you find a way to get dermatology 2 week wait team to put your dad on the cancellations/short notice appointments list?

I think you have the appropriate level of concern, my grandfather had a very similar mass in the same place (his was skin cancer on a non-pigmented part of vitiligo probably caused by sun exposure without any melanin protection over the years). It turned out to have a very deep root that went in sufficiently far that they felt it couldn't be removed (too near lungs etc and would have left a huge hole in his back probably ending the use of his right arm to get it out properly), and it ultimately caused his death.
I hope very much that your one is not the same and can be treated without prohibitive amounts of pain or distress.

Sprigatito So sorry you are dealing with so much at the moment, life can be cruel. I really hope you have good support in place. Maybe it is time to ask for Carers, i know it is hard to hand over care but you have to look after yourself too.

Glad he's been referred op. Agree with you you'd have thought the nurse could've at least sent off a basic set of bloods and checked his temp to get a fuller picture.

Sometimes they seem to not think outside the box and just presumably tick the box of 'urgent referral done'.

I'd ring them tomorrow and ask for some strong pain meds to be prescribed if paracetamol isn't controlling his pain.

Interestingly the 2 week referral gives you an out with Dad going home as well - remember Dad we have to wait to see the specialist because of your back no good going home to come back etc - it will make sense to him. In the mean time I found giving my Mum jobs to do that she could cope with really helped with keeping her active and occupied as it can be very draining. So we would sort and fold washing, polish things, sort out boxes and drawers. writing lists for me when she was still legible. and so on

I cant help wondering why at least a temp check wasnt done, it would be the first step to ruling out an infection that could need antibiotics.

Keep an eye on him over the next two or three days and if there seems to be a sign of infection then request another urgent appointment. Can yiu take his temperature at home to keep an eye? Could you give him a combination of paracetamol 8/500 and ibuprofen?

In the kindest way op, if it is a return of his cancer, it might be a kinder way to go than alzheimers/dementia. We watched my grandmother get to the very end of the disease because she was otherwise fit and healthy. It was awful.

I am sorry you are going through a sad and dark time

The 2 week wait is an urgent referral, but depending on location can also come with a backlog ( sorry I know its not what you want to hear) have you officially temp registered him at GPS? You could also request a pain/meds review in the short term to help, noone should be in pain! Sending love and well wishes to you both.

He needs to see his GP to make a two week wait referral for a dermatology assessment. They will take a biopsy and diagnose.

Oh Op - what a thoroughly shit time you’re having. Nothing new here really to add but would you consider paying for an urgent, private GP appointment? I know where I live I can ring the private hospital an hour away, and get a phone consult really quick for free. Then a face to face usually happens within 24-48 hours (and FYI I dont have private healthcare, so just pay for the appt). While there they might take bloods etc but at least you’d have something started/on file. It can act as a backup second opinion when you do get to a GP.

obviously you want him on an NHS Pathway and treatment but I was very reassured to know quickly what something was/wasn’t a few weeks ago.

Sending strength op, what a lot you have to deal with. I’m pleased you’ve found a place to discuss and download some of your thoughts.