High index of suspicion in skin lesions

MDDUS has seen a recent spate of potentially costly negligence claims involving missed or delayed diagnosis of malignant skin lesions including melanoma.

MDDUS has seen a recent spate of potentially costly negligence claims involving missed or delayed diagnosis of malignant skin lesions including melanoma.

Cases have involved a variety of failures including not referring patients with suspicious lesions, to practice systems errors in which patients have not been asked to return for follow-up appointments leading to a delay in treatment.

The increase corresponds with a general rise in the incidence of skin cancer over the last few decades. In May, Cancer Research UK announced that cases of malignant melanoma have risen by more than 650 since last year, taking the number of cases diagnosed in the UK to over 10,400. In the last 30 years malignant melanoma rates have more than quadrupled and statisticians predict that by the year 2024 this figure could soar to more than 15,500 – making malignant melanoma the fourth most common cancer for men and for women of all ages.

MDDUS advises all GPs to have a high index of suspicion with skin lesions and to follow guidelines with regard to diagnosis and referral. Current NICE guidelines recommend that all patients "with a suspicious pigmented skin lesion, with a skin lesion that may be a high-risk basal cell carcinoma (BCC), a squamous cell carcinoma (SCC) or a malignant melanoma (MM), or where the diagnosis is uncertain, should be referred to a doctor trained in the specialist diagnosis of skin malignancy, normally a dermatologist…"

This recommendation issued in 2006 is unchanged even with the recent announcement that NICE will convene a guidance development group to formally review the recommendations relating to the diagnosis and removal of ‘low risk’ BCCs in primary care – which has been a source of contention among GPs and The British Association of Dermatologists.

The NICE guidance also recommends that: "If there is any doubt about the diagnosis, people with precancerous lesions should be referred directly to their local hospital skin cancer specialist, normally a dermatologist… Where appropriate, follow-up of these patients may be undertaken by their own GP."

ACTION: MDDUS advises members to have a high index of suspicion when dealing with patients who present with worrying skin lesions. If in doubt – always refer. GPs should also ensure that practice systems for histology, referral and results handling are comprehensive and robust.

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