Melanoma is the fifth most common cancer in the UK with 16,000 people being diagnosed every year. The charity Melanoma UK state that melanoma is one of the most common cancers in young people – although 80 per cent of all cases are preventable. However, diagnosing melanoma can be challenging as skin lesions can sometimes appear benign, leading to a delayed or missed diagnosis.
Between 2017 and 2018, there were 79 incidents reported to the MDU involving malignant melanoma, often as a result of a complaint or claim following an allegation of a delayed diagnosis.
Dr Kathryn Leask, MDU medico-legal adviser, said:
"While failing to diagnose a case of malignant melanoma is not necessarily negligent, there may be a case if the claimant can demonstrate that a doctor's management fell below the expected standard – for example, by not actively considering the possibility of a melanoma when a patient presents with typical signs or symptoms and failing to assess them appropriately.
"Consequently, it's important to remember that melanomas can arise on all parts of the body, even in rare sites such as ophthalmic or subungual tumours. One of the MDU cases resulted in an amputation of a digit due to a delayed diagnosis."
To reduce the likelihood of a delayed diagnosis, the MDU advises members to:
- Keep practice protocols and staff training on dermatology up to date and in line with national and locally-agreed guidelines.
- Make sure any patient consultation about a suspicious skin lesion is clearly documented, including the history taken, the examination performed, the differential diagnosis and the management plan.
- Check the patient understands plans for follow-up, and that these are also clearly documented.
- Have in place a protocol for dealing with test results and administrative tasks, such as dealing with messages to and from patients. Protocols are a helpful statement of the expected standard of care to be provided and a definition of responsibilities within the team.
- Ensure the practice has a robust system, such as a significant event audit, for analysing patient safety incidents. This can highlight what lessons can be learned and what changes should be put in place to prevent a similar situation in the future.
- Your practice should also have a safe system for following up test results, including a process for responding to abnormal results and making sure these are communicated to patients.
- Provide patients with an explanation and apology if something does go wrong, particularly if the outcome is poor or unexpected. Take steps to deal with the consequences and arrange appropriate treatment and follow-up.
This page was correct at publication on 11/08/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.