Should I pester the GP more about dermatology referral?

Hi, posting just to see if anyone has ever experienced anything similar.

I'm 51 and last year saw my GP about a large mole on my face (appeared about 5 years ago) and a newer scaly patch I could feel on my back. Turns out the scaly patch is something called Actinic Keratosis, and I was told this was something that happens with ageing, a result of chronic UV damage, and not to worry. The GP did measure the mole on my face, as it is quite big, and said if I ever thought it changed, then I should go back.

Since then I have very slowly noticed more of the actinic keratosis develping on my face. They lurk in my eyebrows, on my forehead and I also have one on my scalp which I can't see, but is a bit itchy and scalier than the rest. So, all in all i have about 9-10. I went back to the GP last week because one of these, on my forehead, has grown a lot in the last month. It is now quite dark red, and is raised like a scaly lump/nodule (the rest are all flat). It feels tender and the top scaly surface sloughs off every few days.

The GP I saw this time was unconcerned. She said didn't think she needed to refer me, but she could if I really wanted her to, but I also needed to be aware that there would be an extremely long wait. I've looked this up, and apparently standard referrals to Dermatology are at 33 weeks in my area. So at the appointment, I said not to bother with a referral.

I am still worried though, as the lesion continues to feel weird. My partner is also worried and says that it is growing a lot, and everything I've read about atinic keratosis "e.g. on British Dermatology Site" says that flags for urgent 2 week referrals are recent growth and raised/elevated lesions - a sign that AK is developing into SCC.

I feel stuck. I would really like to see a specialist (as I don't trust a GP to be an expert in absolutely everything) but can't see how I can get to one without going private or something (which I just can't afford). Does anyone have any suggestions at all? Thanks.

  • If you're getting that information from a reputable site e.g. cancer research, the NHS etc, take a print out and go back to your gp.

    As harsh as it may sound, you have to be an advocate for your own health because some gp's simply assume nothing warrants a referral if it's not got massive neon lighting, with arrows stating "cancer" or "suspect cancer". If the information you are reading is from a reputable site, then you owe it to yourself to seek out a proper second opinion. Even ask to see the original doctor, who showed more concern. No matter what, ignore the last gp and speak to another. If all that fails, and whilst it's not right, you could always initially go private if you have the funds. If the private dermatology appointment flags something up, then your gp would have no alternative but to put you on the suspected cancer pathway.

  • Thank you so much for replying.

    I did as you suggested - actually emailed the practice and asked for the referral. She texted me back this afternoon and has made a referral on the 2 week pathway. It is a big relief to be taken seriously and I will report back following the appointment.

    I hope I'm not wasting anyones time - which is a weird thing to hope for, but I guess you know what I mean.

     

  • Hi Olla,

    I agree with everything Profbaw has suggested. Print out the information from the British Association of Dermatologists and ask to see the first GP again. 

    I know you said you can't afford to go private, but you only need to pay for a private consultation - if the dermatologist says it needs referring then you can go back to the NHS. Ask the private dermatologist for a copy of your consultation and take it to your GP who should then refer you under the 2 week rule.

    Stick to your guns, we patients need to be more proactive (which my dermatologist advocates)!

    Angie (Stage 3 melanoma patient since 2009)

  • As bizarre as it sounds, they want you to waste their time. No treatment means no effort from them, and if it is something, then earlier treatment means less treatment in most cases. If people have genuine concerns, it's better to get told it's nothing than to sit on it for 6 months and get told you should have been seen 6 months earlier when treatment would have been minimal or possible.

    There's a few stories on here where people sat and did nothing for months for various reasons, only to be told they now require more invasive and debilitating treatments.

    It's not as if you're going to the gp for every headache, demanding they check you for a brain tumour or turning up with every minor bruise demanding they check you for a blood cancer. Your concerns are valid, and hopefully they do tell you it's nothing. They prefer telling people good news than bad news.

  • Hello,

    so I had my appointment this morning and everything is ok. I was super worried prior - partly because the lump/nodule got bigger, then got painful, then about 5 days ago it shrank! Oh the irony. Yes, it shrank very rapidly, albeit also became indurated and scabbed over again. I began to worry more about seeming like a fool / drama seeker than anything else.

    Today I saw a nurse practitioner. The total apppointment was super quick. She took a very quick look at my forehead with a dermoscope (a matter of seconds), said it was actinic keratosis, and offered to treat with liquid nitrogen. I managed to get some questions in, and she then treated the lump on my forehead and another on my scalp. Then I was discharged.

    Ultimately I'm glad I went - I don't think I used up much time at all - probably the biggest drain on the system was organising the appointment itself. I feel lucky and relieved, and hopefully things will stay that way.

    Thank for the comments and advice from both of you - it was much appreciated. I hope everyone could be as fortunate as me.

  • So glad to hear you got it checked out, diagnosed and treated quickly. Your perseverance certainly paid off xx

  • Glad to hear it. Now you know it's nothing and can get on with your life.

    Always remember, if you have concerns it's better to get told it's nothing, than it is sitting worrying over it or being told it is something and you should have had it seen to months prior. You absolutely did the correct thing. so don't feel you wasted anyone's time or that you were a drama queen.