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Endgames Case Scenario

Merkel cell carcinoma mistaken for allergic contact dermatitis

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4635 (Published 30 October 2015) Cite this as: BMJ 2015;351:h4635

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Re: Merkel cell carcinoma mistaken for allergic contact dermatitis

I respond to the above "endgames" article, which appeared in the print edition of the BMJ on 30.01.2016 having appeared on line on 30.10.2015.

1) I had no idea that the print version would lag so far behind the on line version. This seems to copy that horrible NHS invention, the "waiting list". I suggest that the BMJ have a "waiting list initiative" and then keep the 2 forms of publication much more contemporaneous!

2) An interesting case no doubt; but why?
a) Did the patient have to present to the emergency dept. when a biopsy had been taken "one month" previously. Had anyone looked at the histology result and why had no action been taken?
b) Why did this 91 year old patient have to go to the emergency dept. anyway? This seems inappropriate to me.
c) How was this apparently extensive lesion treated? Was any treatment other than palliation possible or appropriate?

The BMJ should consider whole patient care in all of their articles. To ignore this gives tacit encouragement to accept tardy and possible sub-optimal patient care.

Competing interests: No competing interests

08 February 2016
Allan P Corder
Retired general surgeon
Previously of Hereford Hospitals (Wye Valley NHS Trust)
Bringsty Common, Worcs.
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