Missed cancer diagnosis – November '23

FJ

It wasn't my patient, so you may think it wasn't my responsibility... but I certainly feel like it was a fail for me as a physician, as a doctor missing a diagnosis in someone close to me.

My close relative was diagnosed with a (desmoplastic) melanoma of the scalp. This is a type of malignant skin cancer. It was widely excised (cut out) with a skin graft and due to incomplete excision at the borders (there was some microscopic melanoma still left), they went on to have radiotherapy.

Here's the bit I missed...

They were undergoing radiotherapy for 4 weeks and during that time other skin lesions appeared nearby. The specialist told us they were unlikely to be cancer.

Over the 4 weeks of radiotherapy, these other neighbouring lesions grew and I didn't notice. I didn't give it a thought. I wasn't the treating doctor, I left it to them. Well, that's my excuse. At the end of radiotherapy the GP sent my relative for further review and biopsy. And to cut a long story short not only were the nearby lesions also malignant melanoma, at this point they had spread to the lungs and liver.

Lucky it's 2023

While a diagnosis of metastic melanoma may seem pretty grim, in 2023 there are treatments that can lead to regression of the tumours. We are optimistic that there is a good chance of this being the case.

Lesson learned

While I can't be responsible for everything medical going on in my family, if it could have serious repercussions then I should keep a closer eye on things. So let me tell you I am totally across how immunotherapy can help with my relative's cancer and there is a 70% chance of response (not necessarily cure, but prolonged life, less symptoms etc). I hope to be writing to you in the near future with a success update.