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?

If you're worried ring 111 and explain what's happened but that you're still worried

He'll see an out of hours doc (my Dad did)

You're in the system now, OP. Chase the referral until you know it's happened and, once it has, you can then get in touch with dermatology to see what they can do to speed it up. If you get them on your side you might find they'll do everything they can to accommodate you as soon as they are able to.

Even if the blood tests showed something sinister it wouldn’t make a referral any quicker so is the most important. If I’m honest, I would have wanted, and expected, the nurse to call in a doctor to have a look but maybe she was a nurse practitioner who has more knowledge and experience. OP can always phone and ask for bloods to be done if she is worried about that.

My two week referral came through in 5 days, for what it is worth.

This is the two week Cancer Pathway, your dad is being processed as quickly as they can... I had a similar event and was originally seen on the Monday, referred and my appointment was the following Wednesday. Your Nurse Practitioner acted as fast as a doctor and frankly taking bloods, temperature etc at this point would be of little value. Whilst action may not seem swift to you currently, all of the right bits of the puzzle are being put in place for the next stage of your journey.

Next, and I know this is difficult, stop looking up what this might be, until you have a biopsy you do not know what it might be and seeing some of the nastier things is doing you no good whatsoever. Until the appointment, make some good memories, live in your dad's world (which you seem to have cracked already) but most of all be kind to yourself and him, because you both deserve it.

The 2 week pathway is as fast as it gets. Even private doesn't happen any faster.

Hi OP. Please don't panic.

Firstly -- I'm a retired GP with a (retired) special interest and a post grad diploma in dermatology.

I'm not going to attempt a diagnosis on your dad's skin lesion; yes, it could be malignant but there are some benign skin lesions which can look similar. I don't think it looks infected from the picture, and A+E will not be able to do a thing. If you go to the out-of hour surgery via 111, the chances are again that he'll be seen by a nurse and nothing extra will be added (but you'll have had extra inconvenience). No-one but a skin specialist (or plastic surgeon, they obviously do a lot of skin surgery too) should attempt to remove it (or biopsy it, or needle it) because only a specialist will know what the likely diagnosis is, and that will inform the treatment.

a 2WW referral is the best thing and you should hopefully be seen within that two weeks. It's possible, but not definite, that the lesion will be removed at the clinic when your dad is first seen. It's unlikely that you would be seen any quicker if you had a private appointment. Dermatologists are like hen's teeth in some parts of the country and private appointments can be well over a month!

It wouldn't be usual at all to take blood tests when referring a lesion like this to a dermatologist and I'm struggling to think in what way a bunch of random blood tests would help your dad or the specialist at the moment. If the dermatologist decides that any blood tests are necessary, they will focus in on specific tests to aid diagnosis and treatment, so again the right thing to do is to wait and see what they say.

Basically, it sounds as thought the nurse at the GP practice has set in place the right procedures, so please don't worry that anything vital has been missed out.

I hope it all works out OK for you and your dad, I understand your worry!

Nothing to do with making the referral quicker - everything to do with clues as to what’s wrong, and giving the dermatologist a raft of blood test results, which they will now have to order themselves, which will take another week to return.

A NP can’t call in a doctor they’d be in a different appointment.

The 2 week wait is the most appropriate referral. Doing blood pressure and temperature would have unlikely showed anything useful unless the practitioner thought it was an infected cyst or something like that, which they obviously didn’t otherwise they would have given antibiotics. If they had decided bloods were needed (which they wouldn’t be indicated in this situation anyway) they wouldn’t have been done on the day anyway as the practitioner wouldn’t have time so it would have been booked on a different day with a support worker probably a week or so from now, by which time you could already have an appointment with dermatology. The practitioner would have had 10 minutes to take a history and make a plan with you, possibly less as you said you’d been squeezed into an already full clinic. If you think more should be done, you (and everyone else who has had issues) probably need to be writing to your MP about the state of primary care services as it’s an absolute shit show and it’s unlikely to improve any time soon due to repeatedly cut funding.

It wouldn't be usual at all to take blood tests when referring a lesion like this to a dermatologist and I'm struggling to think in what way a bunch of random blood tests would help your dad or the specialist at the moment. If the dermatologist decides that any blood tests are necessary, they will focus in on specific tests to aid diagnosis and treatment, so again the right thing to do is to wait and see what they say.

My mother was referred to a dermatologist in January by the GP under the 2 week rule. The GP ordered a whole of lot blood tests, the results of which my mother took to the dermatologist which they reviewed. In this case, given the history of lymphoma a complete blood count would be a start.

Nothing to add but what an amazing,loving daughter you are. Try to be kind to yourself.

Thank you all, I will calm down and wait for the appointment. I'll give it a few days and then phone the dermatology department and ask to be slotted in if there's a cancellation. I'll also stock up on pain killers, the poor bugger is trying to hide it but he's writhing and wincing when he thinks nobody is looking.

If you’re in London and/or the referral exceeds 2 weeks - PM as I can recommend a super efficient private dermatologist who fitted my mum in next day.

My nurse practitioner has called in the doctor when I had a tricky problem. In my hospital the blood tests come back the same day, I get them on my app and my GP can see them too.

I'm nowhere near London unfortunately, but I really appreciate the offer (and your general advice and support on this thread)

Could you go back to the GP and ask for some pain relief in the interim?

A 2WW referral is the appropriate thing for the ANP to have done (pretty sure you saw an ANP). If they had felt that your dad's case exceeded their level of competency they would have called a GP. I suspect he was slotted into an emergency appointment so they would not have had a chance to do a full health review. If his pain is not controlled with standard simple painkillers, you can definitely call or email or do an econsult to request something stronger for him. I would wait for him to be seen by Dermatologists first before pursuing more in depth reviews. It must be a very anxious time for you.

Correct.

To be completely frank, this is something you need to discuss with the NHS rather than the messaging boards here. If he ends up getting very unwell, you’ll regret not going to A&E based on posters here. if he ends up being fine, you’ll regret going to A&E based on posts here. People on here can offer you a place to vent and a listening ear, but I don’t really think it’s the appropriate place to triage A&E visits

Hospital blood tests can come back same day, outpatients can take up to a week.

I'm not trying to worry you but just be aware that after you see the dermatologist the sample that will likely be taken will go to Histopathology and results take much longer than blood and other tests so you may need to wait another 2 weeks after that for the official diagnosis.

I hope if I ever need help someone cares about me as much as you clearly care about your dad.

You are doing great, a big unmumsnetty hug.

Just to clarify, the majority of blood test results would be back within 24 hours, the sort of blood tests that might be appropriate here. The GP would probably not see them the same day unless marked as urgent and chased in the early evening because the bloods don't get to the hospital until late afternoon. The majority would be available to the surgery the following day though.

My hospital bloods ARE outpatients. I get them done regularly because of my health condition. Sometimes they come in before I even get home.

Give it a rest now please.

It’s quite likely that a GP would have done exactly the same, an urgent referral to dermatology, i.e. the 2WW.
IME (family members have had malignant melanoma, squamous and BCC) cancers (if that’s what it is) don’t tend to be dealt with on ‘must deal with today’ type approach. The MMs were removed within a couple of weeks, the Squamous was treated with targeted radiotherapy through a mask but took several months to arrange and the BCC has just been treated with creams.

All the best to you and your family.

You’re not the only person with a health condition that requires regular blood tests. I’m also carer for 2 elderly parents with their own health conditions. Hospital tests come back same or next day, outpatients clinic have taken up to a week.