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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To think we should have had a referral?

15 replies

Terpsichorean · 15/01/2012 09:12

Short version of events...

Quite large (1cm?) pink/tan blob appears on dh's stomach from nowhere. We leave it a few weeks thinking it is a bite or something but after a while it is apparent that it is not going to disappear so he goes to the GP. GP looks at it and says it has "always been there" and does not listen to the fact that it is a new blob. Tells dh it is "benign" and that is that. We don't worry about it any more as it is benign.

Fast forward 18 months and dh sees GP for another skin lesion and mentions the blob. "Ooh that looks funny" says GP and sends dh to have the other lesion biopsied and says to have the blob done at the same time.

Guess what? The blob is MALIGNANT MELANOMA!!

Months of stress, heartache and pain follow. BIG operations and lots of pain take over our lives - children are terrified. No money as dh is self employed.

As a layperson reading the NICE guidelines, it appears to me that dh should have been referred to the hospital/dermatologist 2 years ago. Can any GP's out there let me know if I am reading this correctly?

Many thanks.

OP posts:
missduff · 15/01/2012 09:17

Well I'm not a GP but I do know that a GP can not say that something is benign by just looking at it.

It definitely sounds like you've got a very strong case for a complaint there.

I really hope DH makes a full recovery. Much love x

FabbyChic · 15/01/2012 09:19

Id see a solicitor to be honest, and take legal action.

Terpsichorean · 15/01/2012 10:11

Thanks for your thoughts :)

I'd love to hear from any GP's so that I can see if I am reading this correctly.

OP posts:
TeamEdward · 15/01/2012 10:13

This reply has been deleted

Message withdrawn at poster's request.

catsareevil · 15/01/2012 10:23

Which specific NICE guidelines are you looking at? The one that I have seen that relates to this says that the GP should refer if they have any doubt, but it sounds like the GP didnt have any doubt (Which isnt really the point, but going by the letter of them, the GP could argue they were followed).

I think that the NICE guidelines probably arent the key thing here. They are a guideline, and could be supportive of your case, but they are not cast iron rules, and what you would have to prove is that your GP acted below the standard of a reasonably competant GP.

This link may be useful, it is from a mental health charity, but the general principles apply. You would really need to seek legal advice and get an independent opinion. Do you have any pictures of the mark from 2 years ago?

Terpsichorean · 15/01/2012 10:33

I'm looking at these: www.nice.org.uk/nicemedia/live/10901/28906/28906.pdf

Page 78.

I'm just trying to get my head around why dh wasn't referred earlier as Melanoma in situ is so much easier to deal with. I do have some photos that show the mark but I don't like looking at them!

Thanks.

OP posts:
catsareevil · 15/01/2012 10:44

I suspect that the GP may say that they were sure it was benign (and that therefore they had followed guidelines).

Though in some ways that isnt really the point, if that makes sense. You would need to prove that your GPs standard of care fell below that of a reasonably competent GP. The NICE guidelines on their own won't prove that (though could support your case).

For example there could be things that are not in NICE, and you could still find that GP's agreed that they were essential, or conversely NICE may say something, but if you can find a group of competent GP who agree that it is not essential then NICE wont really help you. Obviously I'm massively over-generalising and its more complicated than that, but essentially the question is whether the care given to your DH was of a reasonable standard. The link that I posted explains it better.

catsareevil · 15/01/2012 10:45

Just to add, I'm not a lawyer, and that isnt legal advice.
If you intend to pursue this you will need a lawyer.

kreecherlivesupstairs · 15/01/2012 10:46

Would you really Fabby?

Terpsichorean · 15/01/2012 10:46

Thanks catsareevil.

Does anyone know how you would tell a lesion is benign without it being biopsied?

OP posts:
BionicEmu · 15/01/2012 11:05

I am not a doctor, but I do work in histopathology, & have done for a number of years. In my opinion there is no definitive way to tell if a skin lesion is benign or malignant without examining it with histopathological techniques. The preference for malignant melanoma is to completely excise the lesion, & then thoroughly examine it; if that would be too intrusive in the first instance then certainly a biopsy would be taken. Typical characteristics of MM include sudden appearance of a lesion, or an existing lesion that enlarges, variable pigmentation & an irregular outline.

Remember, I am not a doctor, this is just my experience, but I really think you should see a solicitor as it seems to me that the GP was negligent.

catsareevil · 15/01/2012 11:25

Agree with bionic emu, the characteristics of the lesion may be a pointer, and obviously not every mark on someones skin can (or should) be biopsied, but was the care that your DH received to a reasonable standard? That is the key thing here.

IWantAnotherBaby · 15/01/2012 12:22

I am a GP. From your description of a 'pink/ tan blob', the lesion does not sound as if it had any suspicious features when your DH first presented with it, but that may just be because you have not mentioned them here (irregular margins, irregular pigment, rapid growing, itching, bleeding, etc).

New lesions appear frequently on the skin of adults, and the vast majority are benign. If the GP documented it properly, and can demonstrate from the record that there were no suspicious features, then they did what the majority of GPs would be reasonably expected to do, and there is no case to answer. Many GPs have a low threshold for referring skin lesions now as it is often difficult to make diagnoses based on clinical examination alone.

The GP will probably also have documented the initial advice given (hopefully something along the lines of 'Come back if it itches/ bleeds/ grows further' etc).

If the lesion, when seen by a dermatologist, was biopsied as you said, rather than completely excised, then they also thought it was benign on clinical examination. (Although even when a lesion is thought benign, most dermatologists will remove the whole thing with good margins.)

Unfortunately atypical melanomas are frequently diagnosed late because they don't have the features that would lead us to suspect melanoma and have benign appearances. If we referred all benign-looking skin lesions then obviously the NHS could not cope with them, and biopsying everything would create unnecessary scarring, infections etc for patients, as well as the time, cost etc that would be involved.

From the minimal information that you have given, I suspect the GP acted completely appropriately based on the initial presentation of the lesion. In addition, unless earlier diagnosis would have changed the ultimate outcome, pursuing a legal claim is likely to be fruitless.

More importantly, is your DH OK now?

Terpsichorean · 16/01/2012 07:41

Thanks IWantAnotherBaby.

I didn't make it quite clear but it was fast growing as it was at least 1cm in just a few weeks. The dermatologist did a complete excision and sent it off for the biopsy.

Please could you explain what you mean by the GP documenting it properly and documenting the initial advice?

Every person we have seen at the hospital have been amazed that we weren't referred at the start or that the GP didn't keep a VERY close eye on this lesion. Apparently (so they tell us) it is well known that not all melanomas are big black moles especially in people with light hair/blue eyes.

Knowing what I know now, I would tell everyone to ask to see a dermatologist as personally I think the risks are too high to leave it to a GP as they simply don't have the time or the correct training to be 100% sure that every lesion is benign. Our consultant agrees with this. I say this as we have met several other people at the hospital that are in fairly similar positions now due to their GP not knowing what their lesion was. I know there will be a cost but what price do you put on someone's life? If we had been told this needed to come off but the NHS didn't have the funds then we would have had it done privately. We would have found the money somehow - you can't mess around with cancer.

The SNB showed no sign of spread which is amazing and not what the consultant expected due to the lesion being there for so long. We have to go back for checks now for 5 years and keep a constant eye out for any changes. Dh can't get life insurance and our whole future will be different to what we had planned.

I am away now for a few days as I need a break but I'll come back later in the week to see if anyone else has any thoughts.

Thanks.

OP posts:
Vasilisa · 22/02/2012 21:01

I wanted to add after reading this that I have friends with experience of pursuing a complaint about a very similar issue.

They had no joy. Amelanotic melanoma as Iwant said is something a lot of primary care doctors have not encountered. Misdiagnosis is therefore probably more common than with the more usual pigmented melanoma.

Rapid growth ought to have been noted by your doctor and I would have thought it a red flag issue, so I would focus on this being, as you state, ignored/dismissed.

I am glad your DH's SNB showed no spread; in the other case of misdiagnosis I'm familiar with, the patient sadly died. Though given the relatively short period of misdiagnosis (just under a year) it is perhaps questionable whether they would have survived for much longer had the MM been correctly identified from the start.

It's simply a tragedy.

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