Another death from a misdiagnosed melanoma
The death from metastatic melanoma has been reported of 24 year old Gregor Lyn. From the story as widely reported, the bare facts are that he went to see his GP about a lesion on his neck in 2019 but was advised that it did not fit NHS criteria for removal. Clearly the GP did not suspect skin cancer or else they would have made an urgent referral. Mr Lyn then went to a private practitioner (details are sketchy) who removed the lesion, or part of it, but did not send the specimen for histological analysis. Histology was an extra £65, which Mr Lyn declined to pay. Next year he went back to his GP as the lesion was still bothering him, was referred to dermatology but was found to have stage 4 melanoma which had spread to his lungs, chest and brain. He died in hospital 2 years after the initial consultation.
My first reaction is of course to think, how sad. But ‘How could this have been avoided?’ is the next thought, and a few others.
The coroner has written to the NHS authorities and raised the issue of the lesion not being sent for histopathology on cost grounds in the private sector while this would have happened automatically in the NHS. But that seems to me not the main issue (although there are VERY strong guidelines about sending all excised skin lesions for histology with the arguable exception of 100% definite warts diagnosed dermoscopically by a skilled person). Without being too judgmental (I have no idea what the lesion originally looked like and its not always easy) the facts is that a GP examined a skin lesion that was in fact a deadly melanoma but they did not suspect a melanoma. The surgeon (whether they were medically qualified or not) also failed to make the correct diagnosis of this skin lesion, as well as incomplete excision and failure to perform histopathology. I’ll bet my second favourite guitar that neither of them used a dermoscope when they examined it.
The last 2 years I was asked to teach the Portsmouth GP trainee group, and expect to do it again this spring. I was given 2 hours to teach them the whole of dermatology. Out of that, I could budget just half an hour to teach these young doctors skin lesion diagnostics. That’s all they will get in their 3 years as GP trainees. Does that sound anything like enough? Skin cancer kills 3,000 people a year in Britain, more than cancer of the cervix, road traffic accidents and meningitis put together. There is no screening program, and people can only see an NHS dermatologist after a GP referral. Everything depends on GPs being able to make a proper diagnosis, but the system is not set up so as to favour this.
The picture below shows a thick, non-pigmented melanoma that was mistaken for something else, leading to delay. It’s not always so easy, which is why GPs need good training.
I hope that the right lessons are learned from this sad affair. It sounds from the speed of disease progress as if poor Mr Lyn had a highly aggressive nodular melanoma, and from the GP’s failure to diagnose it may have been a non pigmented one, which are the hardest to diagnose. Nodular amelanotic melanomas are the black mambas of skin cancer, they are REALLY out to get you and he may have been a dead man walking before he even noticed the lump. There is no guarantee that he would have been saved even if his GP had got the diagnosis right first time, or that the specimen was analysed, but would arguably have had a much better chance.
I am running a one day skin lesion diagnostics and dermoscopy course for GPs in Southampton on Wednesday 24th April 2024, also my Skin Cancer Symposiums friends from New Zealand and Australia are running a 2 day event in Manchester on 28/29 August, and a Masterclass on 30th August. If the GP concerned (I don’t know their name) would like to come on my Southampton course, I’ll give him or her a free place on the course and never speak a word of blame.
Dermoscopy 
Leave a comment