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You are in: Home Page | Personal Injury | Medical Negligence Claims | Clinical Negligence Articles and Clinical Negligence Factsheets | Melanomas and other skin lesions


August 2010

Melanomas and other skin lesions

A skin tumour is an abnormal growth that occurs on the skin which often resembles a swelling. There are many different forms of tumours and while tumours can be benign, pre-malignant or malignant, when referring to skin cancers, these cases are solely malignant tumours.

Skin Cancers

There are two main forms of skin cancer in the United Kingdom:
a) malignant melanoma
b) non-melanoma

a) What is Malignant Melanoma?

Malignant melanoma is a cancerous tumour that develops in the skin cells. It can arise in either current moles or from new ones on normal looking skin. It is the most serious type of skin cancer as it can spread to other areas of the body, but generally only accounts for around 10% of all skin cancer cases.

Excessive exposure to sunlight and its UV radiation is one major carcinogen that causes malignant melanomas, however other factors include exposure to coal, tar, asphalt, creosote, hair dyes and arsenic, positive family history and pale skin.

Prognosis

The prognosis for the patient really depends on how early the malignant melanoma is identified. If the malignant melanoma is in its early stages the prognosis is good and the prospects of achieving a cure are high. However if diagnosis and treatment does not begin until the malignant melanoma has reached an advance stage, prognosis is poor and chances of achieving a complete cure are low.

It is important therefore for the GP or hospital staff to make an early diagnosis and commence appropriate treatment as soon as possible.

b) b) What is the Non-Melanoma group of cancers?

The non-melanoma is the commonest skin cancer in the UK. It is a comparatively less serious type of skin cancer than a malignant melanoma. Non-melanoma skin cancer has two main subsections which are named after the two types of skin cells from which the cancers develop.

1. Basal Cell Carcinoma which affects the cells at the bottom layer of the skin’s surface.
2. Squamous Cell Carcinoma which affects the cells on the outermost layer of the skin’s surface

1. Basal Cell Carcinoma

Basal cell carcinomas themselves are the single, most common malignant skin tumour. Most people are diagnosed in their middle or old age. It does not tend to metastasise (spread) to another part of the body and generally results in a cure. Most cases, like malignant melanoma, relate to excessive sun exposure.

Symptoms:
• A small, slow growing, shiny pink or red lump
• They tend to become crusty and ulcerate
• A flat and scaly discoloured patch of skin that does not heal. These are the cells which constitute the tumour.
  o The patch may be flesh coloured / brown in appearance
  o The patch may grow to cover 10-15cm / 4-6inches of skin.
  o Patches are commonly found on the face, ears and neck.
• A pearly white or “waxy” looking bump which may contain visible blood vessels and are most commonly found on the chest and back
• They are painless but sometimes itchy and occasional bleeding
• They usually appear on parts of the body that have been exposed to the sun (face / scalp / ears / hands / shoulders / back) but they can potentially develop anywhere.

2. Squamous cell carcinoma

This is a less common form of skin cancer, but like the other types relates to sun exposure. It is a more aggressive tumour than basal cell carcinoma as it can metastasise if left untreated.

Symptoms:
• There is a firm pink or red lump with a hard and/or flat scaly and crusted scab-like lesion (graze) that does not heal which are actually tumours.
• They bleed easily and ulcerate
• They usually appear on parts of the body that have been exposed to the sun (face / scalp / ears / hands / shoulders / back) but they can potentially develop anywhere.
• Less commonly, they can also develop inside your mouth, on your genitals, or in your anus.

What is seborrhoeic keratosis?

Seborrhoeic keratosis are very common, harmless lesions that appear during adult life. They look worrying but are entirely benign tumours. Their reasons for appearing are still under debate but many believe they are degenerative in nature - appearing on the skin as it ages. They can grow in number as the skin gets older. They are not directly caused by excessive exposure to sun although can form after sunburn or other irritating conditions like dermatitis. They can be removed for aesthetic or comfort reasons - if it is catching on clothes for example. This procedure is carried out using some of the methods listed below.

Symptoms:
• Initially they are slightly raised, skin coloured/brown spots
• They gradually thicken and develop a rough warty surface
• They may also slowly darken and turn black
• They mimic the appearance of melanoma but are entirely harmless
• They stick to the skin “like barnacles”.
• They can cover all parts of the body and come in clusters or individually

Treatment

The treatment will depend on the location, type and progression of the cancer but types of treatment can include:

  • Shave excision: removes lesions cells from the skin by a series of fine slicings along the surface of the lesion to reduce the height of the protrusion down to the level of the surrounding skin. It is quick, simple and leaves minimal scars.
  • Surgical excision: removal of the cancerous tissue, including some surrounding healthy tissue, with possible skin grafting.
  • Cutterage and electrocautery: a spoon shaped blade to remove the tumour and an electric needle to kill the surrounding cells. For use on small areas of affected tissue.
  • Radiotherapy: low does of radiation to destroy cancerous cells. Used as an alternative to surgical treatment or after surgery.
  • Cryotherapy: Liquid nitrogen is used to freeze the affected tissue, causing the area to scab over then fall off.
  • Mohs surgery: A specialist technique where the tumour is removed bit by bit so that it minimises the removal of healthy tissue, reduces scarring and can ensure the cancer will not spread to other parts of the  body.
  • Chemotherapy: The application of a medicated cream which kills the cancer on the affected surface area.
  • Photodynamic therapy (PDT): A new treatment using a medicated cream and a strong light source to kill the cancerous cells.
  • Topical immunotherapy: A new treatment for small tumours involving a cream which encourages the immune system to attack any cancerous cells in the skin.

NICE Guidelines:

The National Institute for Health and Clinical Excellence (NICE) has published a set of recommendations to guide both doctors and patients about how to manage skin cancers. These can be summarised as follows:

General Advice

1. When a skin lesion is presented to a health care professional, the Glasgow 7 point weighted checklist for assessment should be referred to:

MAJOR criteria:

Change in size:
Irregular shape:
Irregular in colour:

MINOR criteria:

Largest diameter equal to or more than 7mm
Inflammation
Oozing
Change in sensation

Suspicion is greater if a lesion scores 3 points or more (1 major criteria scores 2 points; 1 minor criteria scores 1 point). However if there are strong concerns about cancer, any one feature can lead to an urgent referral.

2. If a patient has skin lesions suggestive of skin cancer or an uncertain diagnosis, they should be referred to a team specialising in skin cancer / dermatologist.

Cases we are dealing with

Most cases we are dealing with involve a delay in diagnosis and/or inadequate excision.

For example a young mother had a lesion on her leg diagnosed as seborrhoeic keratosis and was left untreated by her GP. Subsequently a correct diagnosis of a malignant melanoma was made.

Another case involves an inadequate shave excision of a mole by a consultant dermatologist where again there has been a delayed diagnosis of a malignant melanoma.

In both cases additional surgery was required together with radio / chemotherapy.

A third case involved a GP failing to diagnoses a mole in the groin area as a malignant melanoma until there had been metastatic spread to the pelvis.

It is necessary to prove firstly that the delay which arose represents sub standard care and secondly that the delay made a difference to the outcome.

If you have concerns about how your skin lesion has been dealt with please contact us on 08000 224 224 for some advice or complete one of our online personal injury compensation claim forms.

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Thompsons Solicitors have years of experience in dealing with cases involving clinical negligence.

If you or anyone you know has suffered from any form of clinical negligence, telephone us now for accurate personal injury claim advice.

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Thompsons Solicitors are experts in all matters relating to clinical negligence and will be able to advise you as to whether or not you have a valid personal injury claim for compensation. Our specialist clinical negligence lawyers will be happy to talk you through the process of making a claim in plain English and will be happy to answer any questions or queries you may have.

Telephone us now on 08000 224 224 or complete one of our online personal injury compensation claim forms.