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Monitoring of skin lesions (11HDC00700)
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(11HDC00700, 28 June
Dermatologist ~ A skin cancer detection company ~
Dermatology ~ Skin check ~ Lesion ~ Melanoma ~ Quality standards ~
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
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.