Views & Reviews Personal View

Patients with melanoma are avoiding follow-up to get insurance

BMJ 2012; 345 doi: (Published 03 December 2012) Cite this as: BMJ 2012;345:e7803
  1. Ciarstan McArdle, plastic surgery trainee, Department of Plastic Surgery, James Cook University Hospital, Middlesbrough TS4 3BW, UK
  1. ciarstanmcardle{at}

Malignant melanoma is the fifth most commonly diagnosed cancer in the United Kingdom.1 Incidence has risen fourfold in the past four decades, to 17 cases per 100 000 in 2010, with 85% of patients presenting with localised stage I and II disease.2 Although the predicted survival rates for these patients at five years is 97% and 81%, the impact of melanoma can be life changing for patients, both personally and financially.3

Guidelines on melanoma revised by the British Association of Dermatologists in 2010 recommended up to five years of follow-up after initial diagnosis to examine for evidence of new lesions, recurrence, and potential spread of disease. 4 However, lately in my plastic surgery unit we have seen an alarming rise in the number of patients electing to withdraw from regular review because of difficulties in trying to secure insurance. Patients who do not attend follow-up or …

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