A coroner has issued a warning after a 24-year-old man tragically died from skin cancer due to his decision not to undergo a medical test. Gregor Lynn visited his GP in 2019 to report a “nuisance” lesion on the back of his neck.
However, he was informed that it did not meet the criteria for further investigation within the health service. Mr Lynn subsequently chose to have the lesion removed privately. Still, he decided against paying the additional fee for sample analysis to determine if it was malignant, despite the fact that this procedure would have been provided free of charge by the NHS.
Approximately 14 months later, with the lesion still causing him distress, Mr Lynn returned to his GP and was referred to a specialist who diagnosed him with skin cancer. Unfortunately, scans revealed that the disease had already spread, and despite treatment, he passed away at Addenbrooke’s Hospital in Cambridge just over two years later.
Assistant Coroner for Cambridgeshire and Peterborough, Caroline Jones, has written to the NHS and Department of Health expressing her concerns about the case.
In her Prevention of Future Deaths report, she highlighted the cost of preventing patients who do not qualify for NHS care from undergoing complete procedures, including histological analysis. She stressed that the additional expense was dissuading patients from pursuing further tests when seeking private healthcare.
According to Ms. Jones, “It is of concern that the barrier to undergoing a complete procedure, including histological analysis, appears to be one of cost. Anecdotal evidence received at the inquest from treating clinicians indicated that the additional costs associated with histological or other reviews, which would be routinely included within NHS procedures at no charge to the patient, often deterred patients from opting for further tests.”
While acknowledging the necessity of criteria for routine and non-emergency procedures within the NHS, Ms Jones expressed her concern about the disparity in what is included in private treatment compared to NHS treatment.
She emphasised the potential risk of future deaths if patients who do not meet the NHS referral criteria and must pay for private procedures choose not to have histological analysis due to cost considerations. Early detection and treatment are crucial in minimizing the risks of developing metastatic cancers, including melanoma.
The inquest in August revealed that Mr Lynn initially visited his GP in March 2019 regarding a lesion on the back of his neck. He opted for private treatment, during which the lesion was excised. However, the excised material was not sent for histological analysis, likely due to the additional cost associated with private analysis.
Ms Jones stated, “The consequence of Gregor not meeting the referral criteria for NHS treatment upon initial presentation with a nuisance lesion to the back of his neck was that he had to self-refer for private treatment at a reported cost of approximately £140.
He was advised that the additional cost of histological analysis of the excised samples would be around £65 and decided not to have the samples sent for analysis.”
When the lesion continued to trouble him in May 2020, Mr Lynn returned to his GP, who referred him to dermatology. A further excision was performed and analyzed, revealing melanoma. Subsequent ultrasound scans showed that the melanoma had metastasized to his lymph nodes, chest wall, and lungs.
Despite undergoing immunotherapy and targeted oral therapy, the melanoma continued to spread. In June 2022, scans indicated that it had reached Gregor’s brain, leading to a terminal condition. He was placed on a palliative care pathway and passed away on July 8, 2022, following an admission to Addenbrooke’s Hospital on July 6, 2022.
Ms Jones recorded a verdict of death by natural causes. The Department of Health, NHS England, Cambridgeshire and Peterborough Integrated Care System have until February 14 to respond to her concerns.