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Monitoring of skin lesions (11HDC00700)

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(11HDC00700, 28 June 2013)

Dermatologist ~ A skin cancer detection company ~ Dermatology ~ Skin check ~ Lesion ~ Melanoma ~ Quality standards ~ Right 4(1)

A man complained about the services provided to him by a dermatologist and a skin cancer detection company. In 2003, a man had a melanoma removed from his left arm. Between 2003 and 2010, he had numerous skin checks conducted at a dermatology clinic in conjunction with regular consultations with his GP.

A dermatologist was responsible for assessing the man's images and reporting whether there were any moles or lesions exhibiting suspicious malignant change. Between 2003 and 2009, he reported that there were no lesions or moles of concern. 

In mid June 2009, the man attended a skin check. The melanographer noted concerns in relation to a lesion on his right forearm and asked the diagnosing dermatologist for specific comments. The dermatologist assessed the man's images, including the lesion on his right forearm, and reported that there were no lesions or moles of concern.

In 2010, the man had another skin check. The melanographer again noted concerns about the lesion on the man's right forearm and also noted concerns in relation to a lesion on his right shoulder. The dermatologist assessed the images and reported that the lesion on the man's right forearm was a possible melanoma which should be excised. The dermatologist assessed the lesion on the man's right shoulder as benign but recommended that the man continue to monitor the lesion and to contact his GP if there was any change or continuing concern.

The lesion on the man's right forearm was excised and confirmed to be a malignant melanoma. The lesion on his right shoulder was excised the following year and was confirmed to be an early stage melanoma. Sadly, the man died from metastatic cancer.

It was held that the dermatologist failed to provide services with reasonable care and skill by failing to identify the dermatoscopic changes to the lesion on the man's right forearm, which should have been apparent from as early as 2003. Accordingly, the dermatologist breached Right 4(1). He also breached Right 4(1) for failing to recommend excision of suspicious lesions on the man's chest and right shoulder.

The skin cancer detection company took reasonable steps to assure itself that the dermatologist was meeting quality standards. Its audit programme indicated no concerns about the dermatologist's clinical competency, and a review of his false negative rate confirmed that the man's case was an aberration from the dermatologist's usually very accurate readings of images. There were a number of areas where the skin cancer detection company could improve its programme and systems, there was no evidence that the systems in place at the time were materially deficient. Accordingly, the skin cancer detection company did not directly or vicariously breach the Code.

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