Claim against NHS trust for delayed diagnosis of skin cancer

We have settled a claim against James Paget University Hospitals NHS Foundation Trust for a missed diagnosis of skin cancer which led to a client’s premature death.

In April 2012 our client had a skin lesion removed from the bridge of her nose at James Paget Hospital. The pathology was reviewed and reported as being non-cancerous – specifically, it was diagnosed as being an ‘atypical fibroxanthoma’. The dermatologist responsible for our client’s care discharged her without discussing the matter further within the skin cancer multi-disciplinary team. She received no follow-up.

In early 2013 she began to experience a persistent cough. Her GP sent her for a chest X-ray which was reported as showing some suspicious shading.  A CT scan and biopsy were performed in July 2013 which demonstrated secondary tumours in the lung. She was diagnosed as having metastatic cancer, resulting from the primary cancer from the original melanoma on her nose in April 2012. Her prognosis was extremely poor and she died six months after the diagnosis. 

We were instructed by her husband to investigate a claim for delayed diagnosis and treatment of skin cancer. Expert evidence was obtained from a histopathologist and a dermatologist which concluded that the pathologist had failed to perform the correct laboratory testing on the pathology slides, contributing to a missed diagnosis. In addition, the dermatologist with responsibility for our client’s management should have been concerned by the pathological diagnosis of atypical fibroxanthoma and referred the matter for discussion within the skin cancer multi-disciplinary team in accordance with NICE guidelines. Had our client been discussed within the team, further testing would have been carried out which would have led to a diagnosis of malignant melanoma.

Expert evidence was obtained from an oncologist to consider the impact that the delayed diagnosis had on our client’s treatment options, condition and overall prognosis. Although the delay in diagnosis was relatively lengthy, the oncology evidence was that overall her life was shortened by four months. In the absence of the delay, she would have avoided some additional pain and suffering during the period of delayed diagnosis, her symptoms would have been better managed and she would have had chemotherapy which would have prolonged her life (albeit for a short while). This would have given her more time to come to terms with her diagnosis and to prepare for her death.

A letter of claim was submitted to the trust and the claim was settled after Part 36 negotiations with the NHS Litigation Authority.

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