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My melanoma

Marilyn Eveleigh
Consultant Editor

There were around 8,000 cases of malignant melanoma diagnosed last year in the UK. I was one of them. This is the most serious of the skin cancers with an annual mortality of around 2,000. Prevalence is increasing, but the prognosis is good if diagnosed and treated early.
At the London NIP Event in September 2006, there was an excellent dermatology presentation with graphic illustrations of what to consider when a patient presents with a mole/freckle/birthmark/pigmentation. One photograph looked remarkably like a small birthmark on my right foreleg. After examining it the speaker urged me to request an immediate referral to a dermatologist.
The NHS swung into action, and suddenly I became a patient and an NHS consumer. I had a biopsy within the week and later a further, deeper, wider and total excision of the lesion. A skin graft from my left thigh was used to support the healing of the excision site. As is usual with day cases, I returned to the hospital for monitoring and dressing changes. 
Bedrest, a wheelchair, then crutches followed over the next months. My world was dominated by reorganising simple everyday activities, managing the pain (especially over the donor site), wound dressings and re-evaluating life. My brain and mouth were working perfectly, but I could not get around! I was very dependent on help with mobility and domestic tasks. Time passed, I healed and life went on.
Yet all is not the same. After reflecting on my experience, I have changed as a clinician to better prepare and empower patients and colleagues.
No skin pigment, mole or birthmark is unworthy of scrutiny by a healthcare professional. An opportunistic discussion reminding patients to regularly check themselves for changes in colour, outline and size with or without itching or bleeding, is part of our responsibility. There are excellent patient leaflets that illustrate the monitoring required - and encourage patients to ask doctors and nurses when they are worried. On reflection, I had changes some five months previously, but it seemed too minor to make an appointment for - next time I was at the doctors I would mention it. Am I so different from our patients?  

Well-known NHS issues became a reality
Hospital consultations felt rushed, but the waiting was endless. I wished I'd had written information to go away with. I was shocked by my diagnosis and there was too much to take in. Clinicians who are patients need the same basic information as the rest of the population.
Encouraged by campaigns and my knowledge, I became highly observant about infection control. I did remind clinicians to use the alcohol gel that was readily available. Would other patients have made the same request?
The hospital carpark dominated my visits - including the cost of the charges. Would there be a space near enough for me and my crutches? Would I get clamped if my appointment was delayed through the clinic running late? We should not underestimate this stress for patients.
The district nursing team and my GP had no idea what topical preparation to use on the weekend dressing. This needed specialised skin graft knowledge and communication from the wound care experts would have avoided delay and guesswork.

Some grateful reflections?  
NHS day surgery was absolutely appropriate, and the staff were fantastic, but it does need planning and good domestic infrastructure.
I learnt that walking on crutches is surprisingly
Thank goodness I was at that NIP Event - any conference learning should be incorporated into clinical roles and change practice. This one truly did! 
Now, I never miss the opportunity to raise the profile of early detection by observing moles, freckles and birthmarks. And in the last three months, four people have needed referral as a consequence of my new quest. So, if you get up close to me, you have been warned!

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