Claim follows removal of wrong skin tag

This case is based on a real scenario, with some facts altered to preserve confidentiality.

Dr A ran a private dermatology service for lesion removal.

Mrs G, a 45-year-old woman, was referred to him for removal of a skin tag on her back that had been catching on her clothes.

Mrs G was known to have a number of lesions on her back with a significant history of exposure to sun. She reported she had been seen previously by a dermatologist and had mole mapping, but none had changed.

She reported no red flags and Dr A asked her to identify the tag causing issues, as there were several lesions clustered together on her back.

Dr A marked the lesion and duly undertook removal under local anaesthetic. The procedure was uneventful but two days later Mrs G contacted the clinic to advise she had reviewed the tag in the mirror and seen that the wrong tag had been removed. Dr A offered for Mrs G to return to the clinic to have the correct lesion removed but Mrs G declined.

Two months later Mrs G contacted the clinic again and asked for the lesion to be removed as it was again catching on clothes and bleeding. She also reported it had started to become painful and itchy.

Dr A saw Mrs G again and undertook a dermatoscopic examination of the lesion. The edges were noted to be irregular with crusting and an irregular pigmentation pattern. Dr A was also concerned by the vascularity noted with dermatoscopy.

Dr A explained his concerns about the lesion to Mrs G who consented to an excision biopsy. This was undertaken and pathology revealed nodular malignant melanoma.

Dr A wrote a letter to Mrs G to apologise for the initial incorrect removal. A year later he received a letter of claim. Mrs G’s solicitors were claiming for additional procedures, alleging that had the correct lesion been removed at the first appointment, there would have been no requirement for a second procedure. The letter of claim also alleged that

Dr A should have used a dermatoscope at the first appointment and was seeking compensation for delayed diagnosis of cancer, including pain, suffering, and loss of amenity. It was accepted that the treatment options and prognosis of Mrs G had not been affected by the delay.

Dr A accepted the breach of duty lay in removing the wrong lesion and the claim was settled.

Dr A reflected that had he removed the correct lesion at the first appointment he may not have sent the lesion for histology and the patient may not have had an earlier diagnosis. As a result of this case, Dr A made significant changes to his clinical practice, including initial assessment, obtaining copies of relevant records, and updating his approach to medical record keeping. He also lowered his threshold for using dermatoscopy and for sending lesions for histology.