Advanced melanoma and 3 month dermatology checks

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Hello

My husband has Stage 3b metastatic melanoma with spread to lymph nodes (3cm secondary tumour)and into the tissue of the parotid gland in his cheek. He has had surgery but despite this his oncologist says that further spread is inevitable and he is on Pembrolizumab and obviously it is very important that he attends his every 3 month appointments to be checked by a dermatologist for recurrence as this is quite a large tumour which had already spread outside the lymph node. His dermatologist has left and the CNS has told us that no other dermatologists within the hospital can see my husband (I see there is a 24 week waiting list for dermatology at this hospital). His appointment is now overdue and obviously we are worried that a recurrence is going to be potentially missed when swift treatment is needed in melanoma.

The CNS tells us that they do not get involved in helping with dermatology appointments and that there is no system in place to inform patients of when a new dermatologist is appointed  but she fears it may be sometime as there is a nationwide shortage of dermatologists. So we have a situation where we don’t know when my husband will be given a dermatology appointment and have been told to complain to PALS  - which we have done and so far are still waiting for someone to contact us. We have visited our GP and asked to be referred to the larger regional hospital (under the second opinion rule) where my husband had his surgery. There has been no response so far and the GP did not seem hopeful that the referral would be granted. That leaves my husband without dermatology care when NICE guideline state that Stage 3 melanoma patients should have dermatology checks every 3 months.

Surely the NHS is obliged to offer a 3 month dermatology appointment under these circumstances ? As I’ve said we are willing to travel to the larger hospital or even further afield.

If no NHS dermatologists are available, can we request that a private derm appointment be paid for by the NHS ?

Do patients have a right under the second opinion rule to have their treatment transferred to the hospital of their choice ? Particularly when it means that this would mean that the patient would then be treated by an oncologist who has experience in dealing with their type of cancer and cancer treatment. My husband is currently being treated by a clinical as opposed to a medical oncologist who normally deals with radiotherapy and chemotherapy rather than immunotherapy treatments.

Many thanks.

  • Hi The Boss,

    Welcome to our online community, we hope you are finding this a helpful and supportive place to visit. My name is Emily and I am one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

    I’m sorry to hear you are having difficulty accessing a dermatologist for your husband’s regular skin checks, this must be extremely frustrating for you both.

    As your husband is currently receiving treatment with Pembrolizumab, he will hopefully be having regular check-ups with his oncologist while on treatment.  It may be possible for his oncologist to carry out a skin check as part of these appointments while you are waiting for formal dermatology reviews. Sometimes patients only see their oncologist while they are receiving treatment and not their dermatologist as well to help minimise the number of appointments to attend. This isn’t possible in every treatment centre, but it is certainly worth asking if this could be done for your husband in these circumstances.

    NICE guidelines are a series of recommendations based on a review of the relevant evidence available. Unfortunately, it is not mandatory for these recommendations to be applied by healthcare providers. Local commissioners for healthcare services do have a responsibility to ensure the guidelines can be applied where needed, and you may wish to escalate your concerns about the level of dermatologist availability to commissioner level. How to do this depends on which country within the UK you live in, and you can ask your husband’s nurse specialist or GP to advise you on which commissioning board covers your area.

    The NHS Constitution gives most people living in England the right to choose where to receive treatment. This does depend on several factors, and not everyone has this right. More information about this can be found here. There is no legal right to request a second opinion, but most doctors are happy to refer for this and this seems to be the case with your husband’s GP. If your husband is offered the opportunity to transfer his oncology care to another hospital, it is important to remember that this may result in a delay to his current treatment. This would depend on the capacity and waiting times at his hospital of choice.

    As your husband’s GP has referred him for a second opinion elsewhere, you can potentially use the NHS e-referral service to see if there is a private hospital near to you that offers NHS services. If there is, he may be entitled to request to be seen at that private hospital as part of his NHS care. However, if he chooses to access care at a private hospital that doesn’t offer NHS services, the NHS cannot pay for or subsidise his private hospital treatment.

    It is also important to note that you cannot mix different parts of treatment for the same condition between private and NHS care. More information about how receiving private care may affect NHS treatment can be found here.

    Undergoing cancer treatments can be stressful and upsetting situations, particularly when there are delays or barriers to accessing care. If your husband needed any further emotional support during this time, we are currently offering a course of free counselling for anyone with a cancer diagnosis. This is only available to those with a diagnosis at present, but if you were also requiring emotional support yourself then you are always welcome to contact our emotional support team on our support line. The details of how to do this are below.

    I hope you have found this information helpful. If you wish, you can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or email us. 

    With best wishes

    Emily – Macmillan Cancer Information Nurse Specialist 

    (Our Ref: ER/JC)

     A green “STAFF” badge with rounded corners hangs from a yellow lanyard against a light green background with I am Macmillan staff in black letters.

  • Many thanks for your very detailed and helpful response. Unfortunately the oncology pre infusion checks are conducted by telephone and usually are with a nurse. The oncologist usually deals with bladder and prostate cancer patients and I don't suppose she would be happy being asked to perform a dermatology check. I will continue to do the fortnightly body checks on my husband and it looks as though we will have to pay to see one of the NHS dermatologists at the regional hospital who specialises in skin cancers privately, as we have done on a previous occasion. In any event, we have been told that once my husbands melanoma progresses, he will automatically be referred  to the cancer centre at the regional hospital regardless of waiting times and availability.  So that will solve the problem.....possibly!!!