Thank you for the reply.  I have spoken to my GP, she has never seen an SCC before and seemed to know less than me.  The question I need answered by an expert is what is an acceptable time to wait for removal of a SCC.  I’ve had basal cells removed quicker and they were much smaller.  Isn’t there a pathway?  NICE guidelines state treatment should start as soon after diagnosis as possible.  I had this SCC confirmed by biopsy in October 2023.  Shouldn’t it be removed by now?  Nobody has done anything about it in terms of treatment for over 5 months since the last cryotherapy and it’s getting bigger and bigger.  I’ve had two courses of oral antibiotics as it keeps leaking pus and the pain is increasing.  Not good signs in my humble opinion.  I don’t see the graft taking while it’s so infected and inflamed. It has increased in size from last month and continues to grow bigger and bigger.  Again, I need someone to tell me how long to wait before it becomes outwith the recommended guidance.  I am aware SCC’s are slow growing but mine, after 4 years, is increasing in size at an alarming rate now.

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Hello and thank you for your further post,

I appreciate that you have been waiting a long time for treatment.

In England, if there is a recurrence, treatment should start within 31 days. This time starts from the meeting in which you and your doctor have agreed on a treatment plan. However at the moment, there is no target in Scotland, Wales, and Northern Ireland, but treatment will start as soon as possible.

You mention the SCC is infected and you have had 2 courses of oral antibiotics. I wondered if this is the reason for the delay in having surgery and if the doctors are waiting for this to clear first for surgery to be successful.

You also mentioned that the consultant isn't concerned and that the risk is low. I am not sure when they last saw you, and if they are aware of how big the SCC is getting and how painful it is, they may need to reassess you. It is also worth asking them again to clarify your situation, why you are waiting so long, and why they aren't concerned, even though the SCC is getting bigger, whether it is the infection that is causing the SCC to look bigger or it is getting bigger.

You could try and contact the consultant through their secretary or see if the GP could contact the hospital on your behalf.

I can appreciate this is very frustrating for you and I hope you can get some answers soon.

Kind regards,

Jemma

Hi Jemma, I really appreciate all the information.  It’s both helpful and worrying, if you don’t live in England you can wait a very long time (like me) and not receive treatment.  The SCC ulcerated after the biopsy in November.  I went to the practice nurse at my surgery for antibiotics, she took photos of the fungating tumour and sent them to the Consultant.  I heard nothing for a week so I turned up at the dermatology department.  The receptionist spoke to the consultants secretary who said the consultant had seen the photos and wasn’t worried.  I guess I would know this by telethapy?  I said to the receptionist, it was leaking pus and I clearly needed an antibiotic.  I said I had already gone to the GP and received no treatment, I could go to minor injuries and try there but as it was on the floor down, why would I go there when dermatology knew me.  I felt like I was being a real nuisance to them, so the receptionist eventually said she would ask a nurse practitioner to see me.  She asked me my story, I told her I had SCC and I was waiting on urgent plastic surgery.  She said she wasn’t a prescriber so couldn’t give me antibiotics, but ‘reassured’ me by saying, ‘fingers take a long time to heal’.  Do cancers heal?  It turns out she had been redeployed from the Immunisation Team.  Again, I think I knew more about SCC than she did.

She finally asked the consultant, who was in the department, to have a look.  He gave me antibiotics.  I apologised to the nurse about being demanding, and she said I was quite right to advocate for myself.  This is the battle I am having.  I need to advocate for myself as no one is doing this for me.

I saw the plastic surgeon two weeks ago for the first time.  The SCC is still growing, it’s red, ugly and painful.  I pointed out how it leaks pus, he said that was nothing to be concerned about.  It may be at least 6 weeks before I receive the skin graft, I haven’t received a letter yet.  I cannot understand how the skin graft will be successful if it’s put on infected tissue, so I attended the GP this week and asked for antibiotics.  This is the doctor who hadn’t seen a SCC before, she asked if I’d seen a consultant recently.  I told her what the plastic surgeon had said, about not being concerned about the pus.  I could see her hesitating and thinking, well if a consultant isn’t worried…

I said to her.  It is red, it is painful, and oozing pus.  You know it’s infected, I know it’s infected but because the consultant isn’t treating it you’re becoming doubtful.  Can you understand how I feel when I’m dealing with them? Please do the right thing and give me antibiotics as I cannot see how a skin graft will take without them.  She gave me antibiotics.

I feel so alone, I have lost all faith in the Dermatology department.  I’m thinking if I don’t keep ‘advocating’ for myself I’ll be left for this SCC to go malignant.  If I had known what I know now I would NEVER have sat passively getting six sessions of cryotherapy over 8 months while this SCC progressed from >1cm to now >3cms.  It’s now past the joint in the proximal end of my finger and heading toward the upper joint.

This rant feels so good!  It’s so good to have a safe space to rant, I hate having to confront the people treating me, but I thought they knew what they were doing and were following guidelines and pathways.  I did not realise there are no pathways.