Cancerous moles: the importance of early intervention

Posted: 31/05/2022

Nadia Popovici attended a Vancouver Canucks hockey game against the Seattle Kraken in October 2021 and saved a man’s life.

As she sat in the stands watching the game, she noticed a worrisome mole on the back of the neck of assistant equipment manager, Brian Hamilton, despite only getting a quick glimpse of it. She alerted him by writing a message on her phone and holding it against the glass for him to see.

Nadia noticed that the mole was discoloured, had irregular borders, and was large and raised. All of these characteristics sparked her concern, and thankfully so, as it turned out her instincts were correct - for which she was later awarded with a $10,000 scholarship for medical school from both teams.

Brian subsequently sought medical advice and had the mole checked, which turned out to be cancerous. He was advised that had the diagnosis been delayed by four to five years, the mole would not have been as treatable.

This story demonstrates the importance of moles being checked regularly, and particularly promptly where a mole has any worrying characteristics. Unfortunately, even when a worrying mole is reported to a medical practitioner, the appropriate action isn’t always taken, and avoidable consequences can ensue.

For example, in the case of LC (2015), the claimant’s GP had repeatedly dismissed the claimant’s concerns about a mole on her right thigh that had grown in size, changed colour and become raised. He eventually agreed to remove it and the histopathology report confirmed melanoma. The claimant therefore needed a second wide excision surgical procedure, leaving her with a large scar and indentation. The claim ultimately settled out of court for £10,000 in damages following an admission of liability. The failures alleged by the claimant included:

• A failure to consider her age, and that at her age, new moles should not be growing or changing.
• Failure to urgently refer to a specialist unit.
• Failure to measure lesion with photographs or marker scale at either of her appointments.
• Failure to follow the NICE guidelines 7-point checklist.

This case provides insight into what patients should expect from their GP on reporting a worrisome mole.

The NICE guidelines 7-point checklist is a helpful tool in ensuring patients receive proper consideration by a GP when presenting with a potentially suspicious mole or lesion. It outlines the major features (two points each) and minor features (one point each) of a mole, and practitioners are encouraged to calculate a score based on their observations. A score of three or more indicates greater suspicion and therefore potentially a need for urgent referral, although other risk factors should also be taken into account, such as familial and personal history of melanoma, UV exposure and immunosuppression.

Major features of a mole include a change in size, an irregular shape or border and an irregular colour. Minor features of a mole are a diameter of 7mm or more, inflammation, oozing or crusting and any change in sensation.

Alison Johnson, clinical negligence partner at Penningtons Manches Cooper, represents claimants with claims arising from missed or delayed diagnoses of cancer, including skin cancer, and says: “If you are worried about a mole or lesion on your skin, don’t delay. Have it looked at by your GP immediately as it simply isn’t worth the risk of waiting and your GP will understand your concerns. Your GP may well photograph and/or measure the size of the mole and note this in your medical records for future cross reference. If the mole does look suspicious (with reference to the 7-point checklist), then you should expect to be referred urgently. Finally, in the spirit of Brian Hamilton’s saviour, Nadia Popovici, tell loved ones of the NICE checklist (easily found in full online at the link above) and let someone know if you notice any suspicious moles.”

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