Referral for suspected cancer

A 55-year old man attended his doctor about a skin lesion on his right shoulder. The skin lesion was catching on clothes and bleeding. The general practitioner, an MDU member, carefully examined the lesion and concluded that it was a seborrhoeic keratosis. She was experienced in minor surgery and so offered the patient cryotherapy, which was performed the same day.

Ten weeks later, the patient returned to his GP about an unrelated matter. The GP noted that the cryotherapy site had healed in an irregular fashion. She arranged for the patient to return to the minor surgery clinic in a fortnight, by which time the lesion was red and inflamed. The GP therefore referred him to the fast-track dermatology clinic.

The dermatologist was not able to make a definitive diagnosis based solely on the clinical appearance of the lesion. However, the scar was excised and sent for histology. Unfortunately, this revealed a malignant melanoma. The specialist performed a wide local excision procedure, but shortly afterwards the patient developed lymphadenopathy. A short time later, it became apparent that the patient had developed metastatic disease.

The patient quickly approached a firm of solicitors and brought a claim for compensation against his GP. He alleged that she had failed to recognise that the lesion was suspicious and had failed to urgently refer him to hospital for further investigation. The patient also alleged that it had been inappropriate to perform cryotherapy and that the GP's overall management had resulted in an unnecessary period of pain and suffering.

The MDU claims handler obtained detailed instructions from the member outlining her extensive past experience in dermatology and cryotherapy. She had made her assessment and management plan in full consideration of NICE Clinical Guideline number 27, Referral for Suspected Cancer. On the basis of this, the MDU claims team served a detailed Letter of Response to the patient's solicitors, emphasising that the GP's management had been in line with the seven point checklist for pigmented skin lesions contained in the guideline and liability was denied.

The patient discontinued his claim against the GP and formal legal proceedings were not issued.

Dr Thom Petty
Deputy head of underwriting

This article originally appeared in the printed Good Practice June 2014 issue entitled "Management within guidelines"

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