Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 53
The only safe procedure is to excise all pigmented
lesions when the patient gives a history of change.
However the rate of progression of the Breslow
thickness, as published in peer review journals, is
based on one measurement after excision and an
estimate by the patient as to when the lesion 昀椀rst
appeared and when it changed in character. In
addition the Breslow thickness increases at a faster
rate during the vertical growth phase than during
the radial growth phase.
As a result of this many benign lesions would be
excised but there would be a substantial reduction in
mortality from malignant melanomas and litigation
from missed melanomas would become a feature of
the past.
For a broader look at delayed diagnoses in oncology
and their legal implications, see Litigating Delayed
Diagnosis of Lung Cancer.
Therefore it must be accepted that estimates of the
Breslow thickness by backwards extrapolation are
basically unsound. A description of the lesion and
its change in appearance over time as described by
the claimant or relatives remains the optimum way
of assessing the Breslow thickness at the time of the
breach of duty of care.
Relying on the naked eye or dermascope appearance
of a pigmented lesion may delay the diagnosis
and reduce the chances of cure. A long-standing
pigmented lesion that is exhibiting features of
change or a new pigmented lesion that is increasing
in size should be assumed to be malignant melanoma
until proved otherwise.
About the Author:
Dr Ernest Allan is an Honorary Consultant
Clinical Oncologist at The Christie Hospital one
of the largest and most prestigious cancer treating
institutes in Europe. He retired from clinical work
in 2019, however has an honorary appointment to
enable him to continue his research.
Diagnostic delays aren’t exclusive to skin cancer. Our
post on Legal Insights into Sarcoma explores similar
medico-legal challenges in soft tissue cancers.
Backwards Extrapolation
of Breslow Thickness
Dr Allan spent over 40 years at the Christie’s and
is therefore experienced in the management of
all forms of cancer and able to comment on these
claims. He has been undertaking medico-legal work
for 20 years.
The courts accept backwards extrapolation of the
Breslow thickness in an attempt to assess the Breslow
thickness when there was a failure to identify the
lesion as a malignant melanoma.
Dr. Piers N Plowman
Senior Clinical Oncologist/Radiotherapy
Mr Debashis B Ghosh
MA, MD, FRCP, FRCR, Senior Consultant at St. Bartholomew’s
Hospital and Great Ormond Street Hospital, London.
Consultant Breast & Oncoplastic Surgeon
MS, FRCS (Edin), FRCS (Intercollegiate), FEBS (Breast), FEBS (Surgical Oncology)
Mr Debashis Ghosh is a consultant breast surgeon specialising in the
treatment of breast disease and breast cancer, performing cosmetic breast
surgery and breast cancer surgery (oncoplastic & reconstructive surgery).
Adult and Childhood Cancer.
Radiotherapy, chemotherapy, targeted genomic therapy and
immunotherapy for cancer.
He is currently Clinical Director for Breast, NCL NHS England.
Mr Ghosh's expertise lies in the following cosmetic and corrective breast
surgery procedures:
• Wide local excisions (lumpectomy)
• Sentinel node biopsies
• Axillary node clearance
• Simple and skin sparing mastectomy
• Risk-reducing breast surgery
• Therapeutic mammoplasty
• Oncoplastic procedures and breast remodelling
• Nipple inversion
• Breast augmentation (enlargement)
• Breast symmetrisation
• Breast reduction
• Intraoperative Radiotherapy
Consequences of delays to diagnosis and all causation
issues.
Also specialises in radiation exposure risks – clinical and
other scenarios.
Author of textbook on complications of therapy.
Over twenty years experience as Expert Witness for above.
Also specialises in delay to diagnosis
14 Harmont House
20 Harley Street, London, W1G 9PH
Mr Ghosh works out of the following hospitals:
• Royal Free NHS Hospital London & UCL Medical School
• The Harley Street Clinic London
• The London Clinic
Telephone: 020 7631 1632
Fax: 020 7323 3487
Email: nplowman@doctorplowman.com
EXPERT WITNESS JOURNAL
Contact:
Tel: 020 7205 2281- Fax: 01295 983 031
Email: ml@dbghosh.com
Website: www.dbghosh.com
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JUNE 2026
