Mrs A complained that the Health Board did not take seriously and/or properly progress referrals from her GP, regarding a facial lesion which was diagnosed as being cancerous in May 2024. The investigation focused specifically on whether the Health Board’s assessment of Mrs A’s facial lesion and the GP referrals between August 2020 and September 2023 were clinically appropriate.
The investigation found that the initial management of Mrs A’s lesion in 2020/21 and discharge from the Dermatology service was clinically appropriate.
The investigation also found that, whilst the images shared by Mrs A’s GP with the Dermatology service in September 2023 did not indicate the classical features of nodular basal cell carcinoma (“BCC” – the most common type of skin cancer), they were clinically suggestive of a less common type of BCC which required further assessment. On this basis, following the GP referrals, either a request for additional images with a dermoscope (examination of skin conditions using a dermoscope – a specialised device that magnifies the skin surface) or a face-to-face appointment should have taken place. Rejecting the referrals without any further assessment represented a service failure.
As BCC is a slow growing tumour, it is unlikely to have spread much during the investigation timeframe. Therefore, earlier assessment would not necessarily have altered the treatment Mrs A received or the outcome of that treatment, although there remains a possibility that it may have. This left Mrs A with the uncertainty that earlier review and investigations might have made some difference. The complaint was upheld to this extent.
The Health Board agreed to apologise to Mrs A for the identified failings, to share the report for learning with the relevant clinicians and to review Mrs A’s images at a Dermatology service meeting to identify learning.