SEARCH THIS WEBSITE
Moles can just be part of life but still deserve specialist investigation and prompt treatment when necessary.
If you are unhappy with a mole and visit your GP, two outcomes are relatively common. They could point out that the NHS does not carry out purely cosmetic surgery, or refer you to a dermatologist for a decision.
In the first instance, they would need to be confident that the mole was entirely benign. If an NHS dermatology visit did ultimately happen, the same view might be expressed and treatment declined.
Whilst the dermatologist could require a biopsy, there is again the possibility that decision making would be visually based.
The NHS Rationale
The NHS performs reconstructive surgery, following other treatment, or surgery to correct birth defects, or injuries. They will not help if you would like your nose to be reshaped, or eyelids reduced.
All logical so far, with a waiting list for necessary treatment approaching 8 million. Skin lesions are however a difficult area, when what you see and what is really there are not always the same.
A GP may not have sufficient experience, a dermatologist will be right most of the time but certainty could require further analysis.
A Recent Case
A patient approached their GP about a mole on the back of their neck which they wanted removed. The GP explained that the removal would not meet NHS criteria and the patient would need to arrange private treatment.
They did so and at a cost of £140, had the mole removed but chose not to pay the additional £65, to have a sample sent for analysis.
The patient went back to their GP 14 months later, because the mole area was still causing problems. They were referred to an NHS dermatologist and diagnosed with malignant melanoma, which was found to have reached their lymph nodes and lungs.
Treatment did take place but the cancer later spread to their brain and they were placed on a palliative care pathway, dying soon after.
Questions Raised
The coroner covering the case above raised several questions, including why histological analysis was an additional cost, when this is routinely included as part of NHS treatment. The initial decision by the GP also caused concern.
Nobody can say for certain but skin cancers respond far better to early intervention. Had the condition been diagnosed and treated a year and a half earlier, there is a reasonable chance the outcome would have been different.
We know no more of the case than has been publicly reported and do not wish to apportion blame. GPs try to follow NHS criteria, neither do we know the circumstances of further testing not taking place after removal.
A core question is however whether this case is unique, or others are dying because a cosmetic need turned out not to be. The realistic answer is that they probably are, not least if they can not afford suitable private care.
A Rational Path
Alongside skilled dermatology consultants, good specialist clinics will have modern diagnostic equipment to assist with understanding a lesion. They will also have a close tie with a lab, or one on site.
If any doubt about a mole, or lesion remains, scientific analysis is important. Whilst itemised billing can make sense, presenting the analysis as an optional extra when a specialist is uncertain is not a path we would take.
As a clinic specialising in skin cancer treatment, we would particularly emphasise the point on early intervention. The outcome differences between stage 1 and stage 4 melanoma are vast, more or less back to normal life, or life threatening.
Everyone has a right to their own decisions and to NHS care. For most situations, working out logical paths is not too problematic but moles, or skin lesions are an exception, which should be given very careful consideration.